Non-operative management of patients with rectal cancer: Lessons learnt from the OPRA trial Review

   


Authors: Goffredo, P.; Quezada-Diaz, F. F.; Garcia-Aguilar, J.; Smith, J. J.
Review Title: Non-operative management of patients with rectal cancer: Lessons learnt from the OPRA trial
Abstract: Over the past decade, the management of locally advanced rectal cancer (LARC) has progressively become more complex. The introduction of total neoadjuvant treatment (TNT) has increased the rates of both clinical and pathological complete response, resulting in excellent long-term oncological outcomes. As a result, non-operative management (NOM) of LARC patients with a clinical complete response (cCR) after neoadjuvant therapy has gained acceptance as a potential treatment option in selected cases. NOM is based on replacement of surgical resection with safe and active surveillance. However, the identification of appropriate candidates for a NOM strategy without compromising oncologic safety is currently challenging due to the lack of an objective standardization. NOM should be part of the treatment plan discussion with LARC patients, considering the increasing rates of cCR, patient preference, quality of life, expectations, and the potential avoidance of surgical morbidity. The recently published OPRA trial showed that organ preservation is achievable in half of rectal cancer patients treated with TNT, and that chemoradiotherapy followed by consolidation chemotherapy may an appropriate strategy to maximize cCR rates. Ongoing trials are investigating optimal algorithms of TNT delivery to further expand the pool of patients who may benefit from NOM of LARC. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.
Keywords: treatment outcome; treatment response; review; cancer recurrence; fluorouracil; patient selection; capecitabine; adjuvant therapy; cancer adjuvant therapy; cancer radiotherapy; disease free survival; radiation dose; neoadjuvant therapy; cancer staging; nuclear magnetic resonance imaging; follow up; antineoplastic agent; medical decision making; quality of life; computer assisted tomography; multiple cycle treatment; morbidity; tumor biopsy; continuous infusion; irinotecan; conservative treatment; active surveillance; watchful waiting; colonoscopy; folinic acid; patient safety; patient compliance; expectation; oxaliplatin; rectum cancer; chemoradiation; health care delivery; rectum resection; rectal cancer; rectum abdominoperineal resection; surgical stapling; patient preference; neoadjuvant chemoradiotherapy; colorectal anastomosis; nonoperative management; human; total neoadjuvant therapy; watch and wait
Journal Title: Cancers
Volume: 14
Issue: 13
ISSN: 2072-6694
Publisher: MDPI  
Date Published: 2022-07-01
Start Page: 3204
Language: English
DOI: 10.3390/cancers14133204
PROVIDER: scopus
PMCID: PMC9264788
PUBMED: 35804975
DOI/URL:

https://www.scopus.com/inward/record.uri?eid=2-s2.0-85133130779&doi=10.3390%2fcancers14133204&partnerID=40&md5=cff0cf3f1f099b831fdb9dc1a6fb32ef
Notes: Review -- Export Date: 1 August 2022 -- Source: Scopus
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MSK Authors
  1. Julio Garcia Aguilar
    351 Garcia Aguilar
  2. Jesse Joshua Smith
    224 Smith
  3. Paolo Goffredo
    8 Goffredo
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