RT for the management of locally advanced rectal cancer: Don't throw the baby with the bath water!

Thank you for the opportunity to respond to Dr. ¨Onder’s Letter to the Editor, which permit us to deepen the discussion on the role of radiotherapy (RT) in managing locally advanced rectal cancer (LARC). Pathological complete response (pCR) remains a key endpoint in evaluating preoperative radiochemotherapy (RCHT), as it correlates with local control and survival, although its validity as a surrogate endpoint in the total neoadjuvant treatment (TNT) era is debatable. As noted, the PRODIGE-23 and RAPIDO trials underscore this concern. Nonetheless, achieving improved local responses can facilitate non-operative management (NOM), enabling select patients to avoid surgery and its associated morbidity—a pivotal development in contemporary treatment paradigms.