Novel radiation techniques - A personalised approach for patients with rectal cancer

Surgery remains the standard of care for most rectal cancer as it offers the best chance of cure. However, for patients with early stage low rectal cancers there are several treatment options available using novel radiotherapy techniques. Good responders to novel radiotherapy can avoid surgery. Poor responders need salvage surgery. Patient selection is important and careful assessment after preoperative chemoradiotherapy can identify good responders, even with advanced rectal cancers. Restaging magnetic resonance imaging scans can identify good radiological responses, which need to be confirmed by clinical examination and endoscopy. A watch and wait policy can be adopted for good responders, with surgery avoided or deferred. A boost with contact radiotherapy or brachytherapy can be offered to elderly patients to improve local control. This treatment strategy needs to be evaluated via clinical trials, for which the contact x-ray and transanal endoscopic microsurgery trials have been set up. In this way a personalised approach can be offered for patients with rectal cancer using novel radiotherapy techniques.