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Area of Science:

  • Oncology
  • Radiation Oncology
  • Surgical Oncology

Background:

  • Rectal cancer treatment has evolved with new clinical trial data.
  • Optimizing neoadjuvant therapy sequencing and radiation regimens is crucial.
  • Total neoadjuvant therapy (TNT) and nonoperative management (NOM) are emerging strategies.

Purpose of the Study:

  • To provide evidence-based recommendations for neoadjuvant radiation therapy (RT) in rectal cancer.
  • To guide optimal sequencing of RT and systemic therapy within TNT protocols.
  • To outline considerations for selective omission of RT and surgery.

Main Methods:

  • A multidisciplinary task force updated guidelines based on a systematic literature review.
  • Key questions focused on indications for neoadjuvant RT, regimen selection, and NOM.
  • Recommendations were developed using a predefined consensus-building methodology.

Main Results:

  • Neoadjuvant RT strongly recommended for stage II-III rectal cancer; omission conditionally recommended for low-risk patients.
  • TNT strongly recommended for T3-T4, node-positive rectal cancer, with specific regimens for high-risk recurrence.
  • Concurrent chemoradiation followed by consolidation chemotherapy strongly recommended for NOM prioritization.

Conclusions:

  • Recommendations emphasize multidisciplinary care for optimal RT use in rectal cancer.
  • Future research should focus on personalized treatment regimens based on risk stratification and quality of life.