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Neoadjuvant Therapy in Locally Advanced Rectal Cancer-What Result Should We Expect?

Roxana-Elena Stefan1,2, Adrian Constantin3,2, Daniela Dinu3,2

  • 1Doctoral School, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania.

Medicina (Kaunas, Lithuania)
|May 4, 2026
PubMed
Summary

Predicting response to neoadjuvant therapy for locally advanced rectal cancer (LARC) is crucial. Total neoadjuvant therapy and specific radiation parameters improved outcomes, while elevated CEA indicated a higher risk of poor response.

Keywords:
carcinoembryonic antigenchemoradiotherapylocally advanced rectal cancerlymphocyte countsystemic inflammatory markerstotal neoadjuvant therapytumor regression grade

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Area of Science:

  • Oncology
  • Gastroenterology
  • Surgical Oncology

Background:

  • Neoadjuvant chemoradiotherapy is vital for locally advanced rectal cancer (LARC), improving prognosis and enabling sphincter-preserving surgery.
  • Complete pathological response (pCR) significantly enhances oncological outcomes.
  • Identifying predictors of response to neoadjuvant therapy remains a challenge.

Purpose of the Study:

  • To identify clinical, biological, and therapeutic factors predicting tumor response to neoadjuvant therapy in LARC patients.
  • To find independent predictors of absent complete pathological response.
  • To optimize personalized treatment strategies for LARC.

Main Methods:

  • Retrospective analysis of 122 LARC patients (Jan 2018 - Dec 2023).
  • Comparison of long-course chemoradiotherapy (82 patients) versus total neoadjuvant therapy (40 patients).
  • Analysis of clinical, biological, and therapeutic variables for association with pathological response.

Main Results:

  • Overall complete response (pCR) rate was 17.2% by Ryan score.
  • pCR was more frequent with total neoadjuvant therapy compared to standard chemoradiotherapy.
  • Elevated pre-treatment CEA levels independently predicted unfavorable response; radiation dose and interval to surgery correlated with regression.

Conclusions:

  • Personalizing neoadjuvant therapy is key to improving LARC prognosis.
  • Optimizing tumor regression may expand sphincter-preserving surgery options, enhancing patient quality of life.