Long-term organ preservation after total neoadjuvant therapy

One-paragraph summary

OPRA randomized locally advanced rectal-cancer patients to induction chemotherapy before chemoradiation or consolidation chemotherapy after chemoradiation, then assigned TME or watch-and-wait by response. At five years, disease-free survival was 71% versus 69%; TME-free survival was 39% versus 54%, favoring consolidation. Most regrowth occurred in the first two to three years and salvage was integral to the strategy (PMID 37883738).

Key findings

• About half of consolidation-treated patients retained the rectum at five years.
• Consolidation increased preservation without an apparent DFS penalty.
• Response grading, surveillance and salvage were treatment components.
• Five-year data moved beyond early complete-response reporting.

Limitations

• Phase II and expert-center surveillance.
• No conventional immediate-TME control arm for every patient.
• Functional outcomes require longer, standardized comparison.
• Generalizability depends on MRI/endoscopy and salvage capacity.

Why it matters

OPRA converted watch-and-wait from retrospective observation into a prospective response-adapted strategy and made sustained organ preservation a trial endpoint.

Cited by wiki pages

• Overview
• Localized rectal cancer
• Guidelines
• Clinical trials landscape