Organ Preservation in Rectal & Esophageal Cancer: Radiomics, Molecular Predictors, and Salvage Surgery

Organ-preserving treatment strategies are increasingly being explored for patients with rectal and esophageal cancers, with the shared goal of maintaining oncologic safety while reducing treatment-related morbidity and preserving function and quality of life. Across both disease sites, key challenges include accurate identification of patients who can safely avoid radical resection, reliable assessment of treatment response, and timely, effective salvage interventions when residual disease or regrowth occurs.This Research Topic was designed to bring together multidisciplinary perspectives on organ preservation, spanning imaging, biomarker science, clinical decision-making, and surgical management. Particular emphasis was placed on the development and validation of predictive and response biomarkers, including radiomics and advanced imaging analytics (e.g., MRI, PET/CT, and endoscopy-based imaging), molecular predictors (e.g., tumor genomic and transcriptomic features), and liquid biopsy approaches such as circulating tumor DNA and minimal residual disease monitoring. In parallel, the Topic highlights clinical and practical aspects of implementation, including definitions and reproducibility of clinical complete response, risk-adapted surveillance pathways, and patient-centered outcomes.The contributions assembled in this collection address organ-preservation pathways in rectal and esophageal cancer from complementary angles. Several articles focus on improving patient selection through multimodal models that integrate clinical variables with imaging-derived and molecular features. Other contributions examine surveillance strategies and response assessment, including methodological considerations that may influence comparability across studies and centers. Finally, the Topic includes work that evaluates salvage surgery, including timing, technical considerations, perioperative morbidity, and oncologic and functional outcomes.Collectively, this Research Topic underscores the need for standardized response criteria, robust external validation of biomarkers and predictive tools, and prospective evidence that clarifies which patients benefit most from organ preservation. Continued collaboration across medical oncology, radiation oncology, radiology, gastroenterology, pathology, and surgery will be essential to translate promising predictors and algorithms into safe, equitable clinical practice. Topic editors: Vittorio Patanè, Youssef Bouferraa Source: https://www.frontiersin.org/research-topics/78402/organ-preservation-in-rectal-esophageal-cancer-radiomics-molecular-predictors-and-salvage-surgery