[Neoadjuvant treatment for rectal cancer]

Area of Science:

• Oncology
• Surgical Oncology
• Radiation Oncology

Background:

• Preoperative radiotherapy and total mesorectal excision have improved local recurrence rates for locally advanced rectal cancer.
• While local recurrence is reduced, metastatic recurrence risk remains high (around 30%), and adjuvant chemotherapy benefits are questionable.
• Recent trials investigate neoadjuvant chemotherapy and optimized timing between radiotherapy and surgery.

Purpose of the Study:

• To review recent data on locally advanced rectal cancer management.
• To highlight advancements in neoadjuvant chemotherapy and de-escalation strategies.

Main Methods:

• Review of recent therapeutic trials, including PRODIGE 23 and RAPIDO.
• Analysis of data on neoadjuvant chemotherapy (induction or consolidation) and extended time intervals between treatments.
• Discussion of emerging de-escalation strategies such as organ conservation and non-radiotherapy approaches.

Main Results:

• Neoadjuvant chemotherapy significantly reduces the risk of distant metastasis.
• PRODIGE 23 and RAPIDO trials reported positive outcomes for neoadjuvant chemotherapy regimens.
• Current trends focus on de-escalating therapy, including "Watch and Wait" strategies and local resections.

Conclusions:

• Neoadjuvant chemotherapy is a promising strategy to reduce distant metastasis in locally advanced rectal cancer.
• De-escalation strategies, while not yet fully validated, represent the future direction of treatment.
• Further research is needed to confirm the efficacy of novel therapeutic approaches.