[Neoadjuvant radiochemotherapy for rectal cancer].

Area of Science:

• Oncology
• Surgical Oncology
• Radiation Oncology

Background:

• Neoadjuvant radiochemotherapy is a cornerstone treatment for rectal cancer, particularly when R0 resection is challenging or to improve sphincter preservation.
• Its application in the upper rectum remains debated, necessitating careful reevaluation post-treatment.

Purpose of the Study:

• To review the current indications, challenges, and unresolved questions surrounding neoadjuvant radiochemotherapy for rectal cancer.
• To highlight the limitations of imaging in assessing treatment response and the need for further research into long-term outcomes.

Main Methods:

• Review of current clinical practices and existing literature on neoadjuvant radiochemotherapy for rectal cancer.
• Discussion of diagnostic challenges in post-treatment evaluation and the impact on surgical strategy.

Main Results:

• Neoadjuvant radiochemotherapy indications include unresectable tumors and high locoregional relapse risk, with potential for sphincter saving.
• Post-treatment assessment via imaging is limited; surgical exploration may be needed. Lymph node status alone doesn't predict local relapse.
• Postoperative complication rates are independent of surgical approach. Long-term survival and metastasis data are still pending.

Conclusions:

• The role of neoadjuvant radiochemotherapy in the upper rectum needs further clarification.
• Optimal timing for surgery post-neoadjuvant treatment and management of complete remission cases require determination.
• Ongoing research focuses on novel chemotherapies and treatment regimens to optimize outcomes.