Rectal cancer radiotherapy: 2025 update.

Area of Science:

• Oncology
• Radiotherapy
• Surgical Oncology

Background:

• Standard treatment for locally advanced rectal cancer involves chemoradiotherapy, surgery, and adjuvant chemotherapy.
• While effective in reducing local recurrences, this approach leads to significant functional sequelae and morbidity (20-30%).

Purpose of the Study:

• To present updated recommendations for rectal cancer radiotherapy from the French Society for Oncological Radiotherapy (SFRO).
• To discuss evolving treatment strategies, including neoadjuvant chemotherapy and personalized approaches, aimed at improving outcomes and reducing morbidity.

Main Methods:

• Review of recent clinical trials and treatment guidelines for rectal cancer.
• Integration of advanced imaging (MRI) for margin assessment and refined surgical techniques.
• Implementation of intensity-modulated radiotherapy (IMRT).

Main Results:

• Neoadjuvant chemotherapy followed by chemoradiation improves recurrence-free and metastasis-free survival, establishing a new standard.
• Complete pathological response rates reach up to 30% with neoadjuvant chemotherapy combined with chemoradiotherapy.
• Improved imaging and surgical techniques allow for personalized strategies and reduced morbidity.

Conclusions:

• The efficacy of neoadjuvant chemotherapy necessitates re-evaluating systematic radical surgery in good responders.
• Ongoing trials explore therapeutic de-escalation, including rectal preservation and radiotherapy omission in selected cases.
• Personalized treatment strategies are crucial for optimizing rectal cancer management and minimizing long-term side effects.