AUTHOR=Nguyen Nam P. , Mohammadianpanah Mohammad , SunMyint Arthur , Page Brandi R. , Vinh-Hung Vincent , Gorobets Olena , Arenas Meritxell , Mazibuko Thandeka , Giap Huan , Vasileiou Maria , Dutheil Fabien , Tuscano Carmelo , Karlsson ULF Lennart , Dahbi Zineb , Natoli Elena , Li Eric , Kim Lyndon , Oboite Joan , Oboite Eromosele , Bose Satya , Vuong Te TITLE=Immunotherapy and radiotherapy for older patients with locally advanced rectal cancer unfit for surgery or decline surgery: a practical proposal by the International Geriatric Radiotherapy Group JOURNAL=Frontiers in Oncology VOLUME=14 YEAR=2024 URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2024.1325610 DOI=10.3389/fonc.2024.1325610 ISSN=2234-943X ABSTRACT=

The standard of care for locally advanced rectal cancer is total neoadjuvant therapy followed by surgical resection. Current evidence suggests that selected patients may be able to delay or avoid surgery without affecting survival rates if they achieve a complete clinical response (CCR). However, for older cancer patients who are too frail for surgery or decline the surgical procedure, local recurrence may lead to a deterioration of patient quality of life. Thus, for clinicians, a treatment algorithm which is well tolerated and may improve CCR in older and frail patients with rectal cancer may improve the potential for prolonged remission and potential cure. Recently, immunotherapy with check point inhibitors (CPI) is a promising treatment in selected patients with high expression of program death ligands receptor 1 (PD- L1). Radiotherapy may enhance PD-L1 expression in rectal cancer and may improve response rate to immunotherapy. We propose an algorithm combining immunotherapy and radiotherapy for older patients with locally advanced rectal cancer who are too frail for surgery or who decline surgery.