Cure of rectal cancer without mutilating surgery

Rectal cancer is observed in 12 000 patients each year in France. In nearly all the cases the treatment for cure require a surgery which always remove the whole rectum with a poor bowel function and needs sometimes a permanent diverting colostomy (“a bag”). Since some years a new approach appears possible. The aim is to use radiotherapy and chemotherapy to achieve a total disappearance of the rectal tumor, so called clinical complete response (cCR) and to avoid any mutilating surgery. This strategy was initiated in the I970s by Papillon in France using an original contact X Ray Brachytherapy (CXB) and by Habr Gama a surgeon in Sao Paulo who proposed to her patient a “Watch and Wait” strategy with no surgery when a cCR was observed after chemoradiotherapy. A randomized clinical trial has proven the efficacy of such a combined treatment. With modern techniques of radiotherapy using CXB and linear accelerator combined with oral chemotherapy the chance of success has dramatically increased recently and expert centers use such treatments in France, UK, Sweden and Switzerland.