Precision Therapy in Locally Advanced Rectal Cancer

In this issue of JAMA Oncology, Diefenhardt and colleagues report a post hoc analysis of the previously published German CAO/ARO/AIO-04 trial and found that the ability of patients with rectal cancer to complete planned neoadjuvant (but not adjuvant) therapy was associated with improved disease-free survival. The authors concluded “the findings emphasize the need for appropriate trial design with optimized nCRT [neoadjuvant chemoradiotherapy] dose and schedule and supportive strategies to facilitate good adherence and precision delivery, especially for intensified nCRT.” Few would dispute this broad point, but the greater challenge lies in aligning their recommendations with current paradigms of rectal cancer treatment, which have evolved dynamically since the CAO/ARO/AIO-04 study.

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