Loading
Curing a cancer with drugs and radiotherapy so that the organ (rectum, bladder, larynx, limb) does not have to be removed, keeping surgery in reserve for the minority whose cancer regrows.
Definitive chemoradiation preserves the larynx (VA Larynx trial) and the anus (Nigro); trimodality therapy preserves the bladder in selected muscle-invasive cancer and complete responders to enfortumab vedotin plus pembrolizumab are being spared cystectomy in trials; total neoadjuvant therapy with watch-and-wait for clinical complete responders preserves the rectum in about half of patients (OPRA), and dostarlimab alone cured dMMR rectal cancers without surgery or radiation. Requirements are reliable response assessment (MRI, endoscopy, ctDNA), intensive surveillance and the capacity for timely salvage surgery when regrowth occurs. Patients often accept some extra recurrence risk to keep their organ.
For mismatch repair-deficient rectal cancer, six months of a single antibody now replaces chemotherapy, radiotherapy and an operation, and the same appears to be true for early-stage mismatch repair-deficient cancers of other organs.
Organ preservation became a plan rather than an accident: consolidation chemotherapy after chemoradiotherapy gives the best chance of keeping the rectum, and salvage surgery after regrowth does not appear to cost survival.
The origin of organ preservation in rectal cancer. Twenty years later OPRA made it a planned strategy and the dostarlimab series made it the expected outcome in mismatch repair-deficient disease.
This trial made preoperative chemoradiotherapy the standard for locally advanced rectal cancer worldwide and is the foundation on which total neoadjuvant therapy and watch-and-wait organ preservation were later built.
Shares Total neoadjuvant therapy (TNT, rectal cancer), Total mesorectal excision (TME), Organ preservation in patients with rectal adenocarcinoma treated with total neoadjuvant therapy (OPRA), Randomise organ preservation against surgery in mismatch repair-proficient rectal cancer, with bowel function as a co-primary endpoint.
Shares OPRA, Organ preservation in patients with rectal adenocarcinoma treated with total neoadjuvant therapy (OPRA), Randomise organ preservation against surgery in mismatch repair-proficient rectal cancer, with bowel function as a co-primary endpoint, Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation.
Shares Nonoperative management of mismatch repair-deficient tumors, Organ preservation in patients with rectal adenocarcinoma treated with total neoadjuvant therapy (OPRA), Randomise organ preservation against surgery in mismatch repair-proficient rectal cancer, with bowel function as a co-primary endpoint, Mismatch-repair deficient (MSI-high) colorectal cancer.
Shares Nonoperative management of mismatch repair-deficient tumors, Clinical complete response (cCR), Randomise organ preservation against surgery in mismatch repair-proficient rectal cancer, with bowel function as a co-primary endpoint, Mismatch-repair deficient (MSI-high) colorectal cancer.
Shares Sauer 2004: chemoradiotherapy before rather than after surgery for rectal cancer (CAO/ARO/AIO-94), Total mesorectal excision (TME), Chemoradiation (chemoradiotherapy, CRT), Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation.
Shares Stoma (colostomy, ileostomy, urostomy), Total mesorectal excision (TME), Chemoradiation (chemoradiotherapy, CRT), Rectal cancer.
Shares Watch and wait after chemoradiotherapy for rectal cancer, Total neoadjuvant therapy (TNT, rectal cancer), Total mesorectal excision (TME), Rectal cancer.
Shares Total neoadjuvant therapy (TNT, rectal cancer), Total mesorectal excision (TME), Chemoradiation (chemoradiotherapy, CRT), Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation.