Therapeutic Management of Locally Advanced Rectal Cancer: Existing and Prospective Approaches

Area of Science:

• Oncology
• Surgical Oncology
• Radiotherapy

Background:

• Rectal cancer (RC) incidence is rising, particularly in younger individuals.
• Locally advanced rectal cancer (LARC) management is evolving with new therapeutic strategies.
• Total neoadjuvant therapy (TNT) has emerged as a significant advancement.

Purpose of the Study:

• To review current treatment strategies for rectal cancer.
• To synthesize recent advancements in rectal cancer management.
• To explore future innovations in rectal cancer care.

Main Methods:

• Review of clinical trials (e.g., RAPIDO, OPRA, PRODIGE 23) evaluating TNT.
• Analysis of neoadjuvant chemotherapy and chemoradiotherapy combinations.
• Exploration of organ preservation strategies like watch-and-wait (WW).

Main Results:

• TNT improves overall survival and reduces metastasis and local recurrence rates.
• TNT facilitates completion of oncological treatment and enhances tumor downstaging.
• Debates continue regarding neoadjuvant radiotherapy omission to reduce toxicity.

Conclusions:

• TNT offers improved outcomes for LARC patients.
• Organ preservation strategies and personalized medicine are key future directions.
• Radiogenomics and AI integration hold promise for optimizing rectal cancer treatment.