What Rectal Cancer Patients May Be Able to Safely Avoid Radiation?

Purpose of Review Rectal cancers are treated with chemotherapy, radiotherapy, and surgery. While trials have illustrated the benefits of radiotherapy for locoregional control, recent investigations have questioned the need in select cases. This review seeks to understand why, how, and when radiation can be omitted from rectal cancer management. Recent Findings Absolute contraindications of radiation include pregnancy, and relative contraindications include fertility concerns, sexual outcomes, autoimmune conditions, and prior radiation. Low-risk features of rectal cancer might warrant the omission of neoadjuvant radiation. MRI-directed therapy, chemotherapy alone, and immunotherapy may offer future ways to omit radiation. Summary While radiation continues to be an essential component for rectal cancer treatment, there may be circumstances that it can be omitted. It is important to educate patients that not receiving radiation is a deviation from standard of care. In the future, we may see developments and changes in the treatment paradigm for rectal cancer.