Advances and challenges in treatment of locally advanced XXXX .

@entity1 @entity5
Dramatic improvements in the outcomes of @entity1 with @entity5 have occurred over the past 30 years. Advances in surgical pathology, refinements in surgical techniques and instrumentation, new imaging modalities, and the widespread use of neoadjuvant therapy have all contributed to these improvements. Several questions emerge as we learn of the benefits or lack thereof for components of the current multimodality treatment in subgroups of @entity1 with nonmetastatic locally advanced @entity5 (LARC). What is the optimal surgical technique for @entity5 ? Do all @entity1 need postoperative chemotherapy? Do all @entity1 need radiation? Do all @entity1 need surgery, or is a nonoperative, organ-preserving approach warranted in selected @entity1 ? Answering these questions will lead to more precise treatment regimens, based on @entity1 and @entity5 characteristics, that will improve outcomes while preserving quality of life. However, the idea of shifting the treatment paradigm (chemoradiotherapy, total mesorectal excision, and adjuvant therapy) currently applied to all @entity1 with LARC to a more individually tailored approach is controversial. The paradigm shift toward organ preservation in highly selected @entity1 whose @entity5 demonstrate clinical complete response to neoadjuvant treatment is also controversial. Herein, we highlight many of the advances and resultant controversies that are likely to dominate the research agenda for LARC in the modern era.
