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[Comment] Improving quality of life after treatment for rectal cancer

In rectal cancer, findings from large randomised trials have provided solid evidence that preoperative (chemo)radiotherapy decreases local recurrence rates by 50%, compared with surgery alone.1 This decrease, however, comes at the cost of an increased incidence of anorectal and urogenital dysfunction, and, based on better imaging methods of today, many clinicians advocate a more selective policy of neodjuvant radiotherapy, with the goal of maintaining better quality of life. At the same time, there is a reverse strategy with the same goal of maintaining a better quality of life: start with radiotherapy and tailor subsequent surgery according to the response: total mesorectal excision after little or no response, local excision after a very good response, or even no surgery after a complete response.