Total neoadjuvant therapy for rectal cancer

Area of Science:

• Oncology
• Surgical Oncology
• Medical Oncology

Background:

• Combined modality therapy has improved outcomes for locally advanced rectal cancer.
• Distant progression, not local failure, is now the primary cause of death.
• There is a need for risk-adapted treatment strategies focusing on micrometastatic disease.

Purpose of the Study:

• To review the emerging literature on treatment sequencing for locally advanced rectal cancer.
• To critically appraise the total neoadjuvant therapy paradigm.
• To explore options for omitting components of multimodality therapy.

Main Methods:

• Literature review of emerging studies.
• Focus on neoadjuvant chemotherapy sequencing.
• Analysis of total neoadjuvant therapy and de-escalation strategies.

Main Results:

• Increasing interest in neoadjuvant chemotherapy over postoperative chemotherapy.
• Total neoadjuvant therapy is a key emerging paradigm.
• Investigating the potential to omit certain treatment components.

Conclusions:

• Risk-adapted strategies are crucial for locally advanced rectal cancer.
• Neoadjuvant chemotherapy is increasingly favored to address micrometastatic disease.
• Future research should focus on optimizing treatment sequencing and de-escalation.