Strategies to reduce intestinal toxicity in neoadjuvant management of locally advanced rectal cancer

The management of locally advanced rectal cancer has progressively evolved to improve both survival outcomes and quality of life. Intestinal toxicity is a prevalent side-effect of pelvic radiotherapy affecting most patients. The pursuit of neoadjuvant intensified treatment strategies to enhance response rates or facilitate organ preservation may lead to an increased likelihood of late toxicity, depending on radiation technique and chemotherapy intensity. This narrative review synthesizes current knowledge on radiation-induced intestinal toxicity, refines effective strategies, with an emphasis on studies evaluating techniques to reduce both unintended and intended radiation exposure to the small intestine in locally advanced rectal cancer patients, and highlights their clinical significance.