In our previous discussions, we've firmly established the role of neoadjuvant radiation therapy for locally advanced rectal cancer. However, radiation, while life-saving, comes with its own set of acute and late toxicities—from sexual dysfunction and infertility to chronic bowel changes and the rare risk of secondary malignancies. This raises a crucial question in modern oncology: for whom can we safely omit radiation, de-escalating treatment without compromising oncologic outcomes? Today, we delve into this concept, focusing on a landmark trial that has reshaped our approach to low-risk rectal cancer: the PROSPECT trial. We'll analyze its design, uncover its key findings, and learn how to identify the specific patient population for whom radiation can potentially be spared.

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