Total Neoadjuvant Therapy for the Treatment of Locally Advanced Rectal Cancer

The treatment of locally advanced rectal cancer has been transformed over the last century. While initially treated with surgery alone, adjuvant therapy with chemotherapy and radiation became common for locally advanced disease to prevent local and distant recurrence. Several trials subsequently showed benefit to moving this therapy into the neoadjuvant setting which led to improved oncologic outcomes, greater compliance, and similar surgical morbidity. In this article, we will explore this historical transition to a total neoadjuvant approach that can lead to cure in select patients and brings into question the role of surgery altogether.