Organ Preservation After Total Neoadjuvant Therapy in a Patient With Low Rectal Adenocarcinoma and Crohn's Disease

Inflammatory bowel disease (IBD) is a relative contraindication to radiation. This case report describes a 53-year-old man with colorectal adenocarcinoma and a history of Crohn's disease who was treated under the organ preservation for rectal adenocarcinoma protocol to avoid total mesorectal excision. Over 30 months of follow-up, the patient continues to tolerate chemoradiotherapy and consolidation chemotherapy with manageable toxicity and achieved a sustained complete clinical response. This case supports emerging evidence that radiation may be feasible in select patients with IBD and highlights the potential role of non-surgical organ preservation strategies in colorectal cancer, even in the context of underlying IBD.