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.
