Tailoring treatment for locally advanced rectal cancer

The management of locally advanced rectal cancer (LARC) requires personalized treatment to improve outcomes and maintain quality of life. This narrative review examines the recent developments in management, focusing on non-operative management, radiotherapy choices or omission, chemotherapy sequencing, and the role of immunotherapy and brachytherapy boost. Non-operative management can be an option for select patients, and the use of long-course chemoradiation (LCCRT) with consolidation chemotherapy or brachytherapy boost has been shown to enhance rectal preservation rates. For patients requiring surgery, the choice between LCCRT and SCRT depends on the risk of local recurrence and patient preferences. MSI-high LARC patients benefit significantly from single-agent immunotherapy, and early clinical trials show promising results for the application of immunotherapy in MSS tumors. By stratifying patients based on individual and tumor risk factors, clinicians can tailor treatment plans to improve oncologic outcomes and quality of life for patients with LARC.