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Organ Preservation

 

Organ Preservation

Chairs: 

  • Thomas Brunner, Radiation Oncologist, University Hospital for Radiation Therapy Graz, Austria
  • Pierfrancesco Franco, Radiation Oncologist, University of Eastern Piedmont, Italy

 

Speakers: 

  • Emmanouil Fokas, Radiation Oncologist, University of Cologne, Germany

  • Simon Bach, Colorectal surgeon, University of Birmingham, United Kingdom

  • Jörg Lindenmann, Thoracic surgeon, Medical University of Graz, Austria

  • Marcel Verheij,  Radiation Oncologist,Radboud UMC Nijmegen, The Netherlands

 

Target Audience

Professionals who are interested in gastrointestinal oncology further developing the field of organ preservation in radiotherapy, including radiation/clinical oncologists, medical physicists, RTTs and nurses - both at their early career or senior professionals.

Description: 

Decades after anal cancer patients have started to benefit from organ preservation by chemoradiotherapy, to date organ preservation strategies in radiation oncology represent a paradigm shift in treating oesophageal and rectal cancer, offering patients the possibility of cancer cure while maintaining quality of life through functional organ retention. This approach challenges traditional surgical dogma and demands interdisciplinary collaboration to optimize outcomes.

For oesophageal cancer, definitive chemoradiotherapy has evolved from a palliative measure to a curative option for selected patients. The CALGB 80803 trial has demonstrated that intensified chemoradiotherapy regimens with newer cytotoxic agents significantly improve pathological complete response rates, bringing organ preservation within reach for more patients with adenocarcinoma and due to the even higher complete response rates in squamous cell carcinoma prospective trials have started to test this approach also with this pathological type. Revolutionary advances in molecular imaging—particularly FAPI-PET targeting cancer-associated fibroblasts—provide superior tumour delineation and early response assessment compared to conventional FDG-PET. When combined with circulating tumour DNA analysis, these biomarkers enable much higher accuracy in predicting complete response than before, with the aim to allow clinicians to confidently identify patients who can safely avoid oesophagectomy. Immunotherapy integration post-chemoradiation shows promising complete response rates, potentially expanding organ preservation candidacy.

Rectal cancer organ preservation has matured considerably, with total neoadjuvant therapy (TNT) achieving clinical complete response rates exceeding 30% in selected patients. The watch-and-wait strategy, supported by landmark studies like the OPRA and the OPERA trial including brachytherapy, demonstrate that surgery can be safely omitted in sustained complete responders without compromising survival. Novel biomarkers including circulating tumour DNA and radiomic signatures are emerging to predict response and guide personalized treatment intensification.

Critical questions remain: Which patients benefit most from organ preservation? How do we optimize radiotherapy dose, fractionation, and systemic therapy combinations? What role do emerging technologies—proton therapy, MR-Linac, artificial intelligence—play in enhancing outcomes? When should we intervene in incomplete responders?

Answering these questions requires multidisciplinary research teams spanning radiation oncology, medical oncology, surgery, radiology, pathology, and molecular biology. We must establish prospective registries, conduct harmonized trials, and share data internationally to accelerate discovery.

The future of organ preservation depends on our collective commitment to rigorous scientific inquiry. Join us in transforming cancer treatment—preserving not just lives, but the quality of those lives.

Objectives

  • Who are the ideal candidates for organ preservation in oesophageal and rectal cancer?
  • What are the multidisciplinary requirements to optimize outcome for both, responders and non-responders?
  • Which trials are needed to foster scientific and clinical progress in the field?
  • Discuss implementation strategies for patient-centred approaches in clinical practice

 

Disease sites of interest

  • Oesophageal cancer, both squamous cell and adenocarcinoma
  • Rectal cancer

 

Potential Outcomes

  • Identify all elements required to maximise the rates of organ preservation in both organ sites
  • Design trials that will improve weak links in the treatment chain to overcome these restrictions.
  • Enhance collaboration between radiation oncology, medical oncology, gastroenterology, surgery and radiology to improve patients’ journeys who are candidates for organ preservation

 

Workshop programme

Day 1 – Thursday 12 March 2026

10.45–12.45
Session 1

Moderation: M. Verheij and P. Franco

Organ preservation in RC

Lecture (20’+5’): Patient selection/cCR definition and role of endoscopy and imaging for surveillance programme / salvage surgery

Speaker: S. Bach

Lecture (20’+5’): Treatment algorithms and European / International Guidelines in RC: what is considered standard of care for radiotherapy in the organ preservation setting (TNM-based, RT indications, short-course RT, chemoradiation, TNT, brachytherapy)?

Speaker: E. Fokas

Organ preservation in OEC

Lecture (20’+5’): Patient selection/cCR definition and role of endoscopy and imaging for surveillance programme / salvage surgery

Speaker: J. Lindenmann

Lecture (20’+5’): Treatment algorithms and SANO Standards in OEC: what is considered standard of care for radiotherapy in the organ preservation setting (TNM-based, RT indications, chemoradiation, TNT, brachytherapy)?

Speaker: M. Verheij

12.45–13.45
Lunch
13.45–15.45
Session 2

Moderation: M. Verheij and P. Franco

Quality of life, PROMs and functionality tools

Lecture (20’+5’) on RC: Quality of life (QoL), Patient Reported Outcome Measures (PROMs) and functionality tools

Speaker: S. Bach

Lecture (20’+5’): Ongoing and planned clinical trials on combined modality treatment, including immunotherapy with or without RT

Speaker: E. Fokas

Lecture (20’+5’) on OEC: Quality of life (QoL), Patient Reported Outcome Measures (PROMs) and functionality tools

Speaker: J. Lindenmann

Lecture (20’+5’) on OEC: Ongoing and planned clinical trials on combined modality treatment, including immunotherapy with or without RT

Speaker: M. Verheij

15.45–16.15
Coffee break
16.15–17.15
Session 3

Moderation: M. Verheij and P. Franco

Tumour board on RC and EC

Case presentations (by participants and teachers) and questions on organ preservation: bring your own cases and discuss with experts and other participants.

Participants: Participants / all 4 teachers of the organ preservation theme

17.15–18.15
Final session

Progress reports of the five breakout groups

Participants: All participants together

Day 2 – Friday 13 March 2026

08.00–09.00
Session 1

Moderation: T. Brunner and P. Franco

Identifying unmet needs in organ preservation in RC and OEC

Biomarkers (e.g. ctDNA/cfDNA), timepoint of response assessment, response-adapted escalation/de-escalation, QoL endpoints, and additional data on functionality.

Speakers: S. Bach, E. Fokas, J. Lindenmann, T. Brunner

09.00–10.00

Designing clinical and translational protocols

Participants: Participants / all 4 teachers of the organ preservation theme

10.00–10.30
Coffee break
10.30–12.00
Session 2

Moderation: T. Brunner and P. Franco

Discussion of next steps and take-home messages

Including multidisciplinary challenges of setting up organ preservation with SWOT/SMART goal setting.

Participants: Participants / all 4 teachers of the organ preservation theme