Préservation d’organe dans les cancers du rectum : quels arguments en faveur de la radiothérapie ?

Abstract

Standard care for rectal cancers relies on both tumor (location relative to the sphincter, T and N stage, sphincter involvement) and patients characteristics. Radical surgery (total mesorectal excision) following short-course radiotherapy (RT) or standard chemo-radiotherapy, associated with induction or consolidation chemotherapy (total neoadjuvant treatment), remains the cornerstone of locally advanced rectal cancer (T3cd, T4 and/or N+) treatment. Nevertheless, for early stages, this radical resection could be avoided in favor of conservative approaches combining RT (external, contact, brachytherapy) with or without chemotherapy (concurrent, induction or consolidative), or even be limited, for good responders, to a local excision with view of organ-preservation strategies. This conservative approach could also be offered selectively to patients with complete clinical response after the induction sequence, irrespective of initial tumor characteristics. The Watch and Wait strategy relies on clinical, endoscopic and radiological evaluations, as well as sustained surveillance. Ongoing studies aim to improve response rates, either with chemotherapy intensification, or RT boost dose escalation with brachytherapy or contact-therapy.