Going rogue with the rectum.

Reports of complete pathologic response (pCR) to neoadjuvant treatment are typically communicated to patients with congratulations. But should it be done with apologies? Neoadjuvant chemoRT for T3-4 or N1 rectal CA is standard of care and achieves pCR in approximately 1 in 5 people. This month’s JAMA Onc op ed focuses on the evidence for observing patients with a clinical CR, with salvage surgery achieving survival times equal to those with pCR on upfront surgical path. So why remove these healthy rectums? An opposing companion piece argues that forfeiting local control after decades of hard-fought advances to the contrary would be careless at best. Good thing there are two RCTs assessing organ preservation in low-lying rectal CA now closed to accrual and due to report final outcomes in 2018 and 2019. So if you’re torn between tried & true and not having to tell the rectum adieu, consider enrolling your patient in an open clinical trial to help rectify the rectal cancer paradigm.