On a prolonged interval between rectal cancer (chemo)radiotherapy and surgery

Area of Science:

• Oncology
• Surgical Oncology
• Radiation Oncology

Background:

• Preoperative radiotherapy (RT) or chemoradiotherapy (CRT) is crucial for rectal cancer management, aiming to reduce local recurrence and enable radical tumor removal.
• Complete tumor response to RT/CRT can facilitate organ-preserving strategies, avoiding extensive surgery.
• Recent trends show a prolonged interval between the end of RT/CRT and surgical intervention or the decision not to operate.

Purpose of the Study:

• To review the literature and discuss the relevance of the time interval between preoperative RT/CRT and surgery for rectal cancer.
• To provide evidence-based recommendations for optimal timing based on treatment indications and patient factors.

Main Methods:

• Literature review focusing on the timing of surgical intervention post-RT/CRT in rectal cancer.
• Analysis of different treatment scenarios including intermediate and locally advanced tumors, and organ preservation goals.

Main Results:

• For intermediate rectal cancers, short-course RT with immediate surgery is suitable for reducing local recurrence without downsizing.
• In elderly patients or those at risk of surgical complications, delaying surgery for 5-8 weeks is recommended.
• For locally advanced tumors treated with CRT, an optimal delay of 6-8 weeks is suggested. For organ preservation, evaluation at 6 weeks with potential surgery at 8 weeks, or reassessment at 12 weeks for 'watch-and-wait' is discussed.

Conclusions:

• The optimal timing for surgery after preoperative RT/CRT in rectal cancer is highly dependent on the initial indication for treatment and tumor response.
• Strategic delays can improve outcomes, facilitate organ preservation, and manage patient-specific risks.
• Adjuvant chemotherapy during the waiting period shows promise for enhancing treatment efficacy.