Changing patterns of neoadjuvant therapy for locally advanced rectal cancer: A narrative review

Abstract

Standard treatment for patients with locally advanced rectal cancer has been the multidisciplinary approach of neoadjuvant chemoradiotherapy, followed by total mesorectal excision (TME) and postoperative adjuvant chemotherapy. This reduces the local recurrence rate, but the challenge of distant metastasis still persists. The improvement in treatment approach has always been the focus of clinical research and studies have been conducted worldwide in recent years. On one hand, evidence suggests that increasing the intensity of treatment can result in better tumor regression, for example by adding a second drug to the neoadjuvant chemoradiotherapy, or extending the interval between neoadjuvant therapy and surgery, or incorporating chemotherapy and chemoradiotherapy in the neoadjuvant setting. On the other hand, neoadjuvant immunotherapy and selective omission of neoadjuvant radiotherapy may improve the quality of life of patients. In this article, we review the key clinical research progresses in neoadjuvant therapy for locally advanced rectal cancer, hoping to provide some valuable views on the individualized treatment for rectal cancer.

Keywords: Immunotherapy; Locally advanced rectal cancer; Neoadjuvant chemoradiotherapy; Total neoadjuvant therapy; Waiting period.