Recent_Advances_in_Rectal_Cancer_30Slides.pptx

Presentation about rectal ca advancement

1. Recent Advances in Rectal Cancer Focus on Locally Advanced Disease, TNT & Organ Preservation Dr. Yasiru Malinda 22/8/2025

2. Epidemiology & Burden

3. Current Challenges in LARC

4. Traditional Approach Limitations: poor compliance delayed systemic therapy CRT → Surgery (TME) → Adjuvant chemo

5. Total Neoadjuvant Therapy (TNT)

6. RAPIDO Trial TNT: SCRT + chemo → surgery

7. PRODIGE-23 Trial Induction FOLFIRINOX → CRT → surgery ↑ DFS, ↑ pCR Proof of intensified systemic upfront chemo

8. OPRA Trial Induction vs consolidation TNT Consolidation → ↑ organ preservation (W&W) ~50% long-term organ preservation

9. OPERA Trial CRT ± radiotherapy boost (Papillon) Boost → ↑ OP rates in cCR Selective boost promising

10. Organ Preservation Concept Aim: avoid TME if cCR Requires MRI/endoscopy/DRE follow-up Preserves bowel/urinary/sexual function

11. Watch-and-Wait Safe in cCR with strict follow-up OP maintained in >50% Comparable OS

12. Papillon Contact X-Ray Brachytherapy Direct high-dose X-ray boost >80% local control early cancers Used in Europe selectively

13. Local RT Boost Approaches HDR brachytherapy IORT Improves regression in borderline responders

14. Immunotherapy in Rectal Cancer MSI-H/ dMMR → PD-1 blockade effective NEJM 2022: Dostarlimab trial 100% cCR in small cohort

15. ESMO Guidelines 2025 TNT for high-risk LARC Organ preservation in cCR Immunotherapy for MSI-H ctDNA emerging tool

16. Management Algorithm

17. Functional Outcomes & QoL TNT better systemic control Organ preservation avoids TME morbidity QoL benefits substantial

18. Future of TNT Combination with immunotherapy Biomarker-based selection Radiomics & AI prediction models

19. ctDNA Predicts recurrence risk Guides adjuvant therapy (trials ongoing) Still investigational

20. Summary of Key Trials RAPIDO → systemic control PRODIGE-23 → intensified upfront chemo OPRA → OP feasible OPERA → RT boost

21. Evolving Surgical Role TME reserved for non-responders Less radical resections in cCR Laparoscopic/robotic improving outcomes

22. Multidisciplinary Team Role Radiology: MRI staging & response Surgery: selective TME Oncology: TNT & systemic therapy Radiation: RT boost

23. Conclusion TNT is new standard for LARC OP feasible in many with cCR Immunotherapy revolution for MSI-H

24. References NEJM, Lancet Oncology, JCO, ESMO

25. Thank you Questions?