Evolution in rectal cancer management
Mené sur 180 patients atteints d'un adénocarcinome du bas ou moyen rectum de stade II-III (durée médiane de suivi : 35 mois), cet essai multicentrique de phase II évalue l'efficacité, du point de vue de la survie sans récidive à distance à 30 mois, d'un traitement néoadjuvant total suivi d'une prise en charge non chirurgicale
Non-operative management after a clinical complete response following neoadjuvant treatment in rectal cancer, often referred to as opportunistic non-operative management rather than intentional non-operative management (ie, up-front treatment for early-stage patients with the aim of non-operative management), is increasingly being implemented. Provided meticulous follow-up, data suggest that non-operative management is feasible, safe, and associated with favourable overall survival. However, challenges remain, such as response assessment after neoadjuvant therapy, management of near clinical complete response,3 and whether distant control is affected. The NO-CUT trial in The Lancet Oncology specifically addresses distant control and provides valuable insights into other aspects of non-operative management. The first generation of randomised controlled trials on total neoadjuvant therapy, which used chemoradiotherapy or short-course radiotherapy, induction or consolidation chemotherapy, and diverse inclusion criteria, showed that 20–30% of patients obtain a pathological complete response. Among patients who had surgery and had pathological complete response, oncological outcomes are excellent.7 Because non-operative management was not an option in these early trials, less is known about the long-term distant control in patients with clinical complete response.
The Lancet Oncology , commentaire en libre accès, 2025