Current neoadjuvant strategies in rectal cancer

Abstract

Treatment modalities in rectal cancer have undergone a slow, evolutionary transition over the past 30 years. More recently, contemporary descriptions of advanced preoperative chemotherapy and radiation schema have led to a rapid revolution in the management of this disease. In this review we focus on current evidence-based neoadjuvant strategies used in the treatment of locally advanced rectal cancer and metastatic rectal disease. Finally, we provide a foundation for discussion of still unresolved issues.

Erectile and urinary function in men with rectal cancer treated by neoadjuvant chemoradiotherapy and neoadjuvant chemotherapy alone: a randomized trial report

“…These results indicate that we need more information on possible benefits and harms of treatment options for oncologists and patients to make better, more successful decisions. Preoperative 5-FU-based CRT has become standard treatment for stage II-III rectal cancer [15], but whether these patients really need radiation for local control is unclear.…”

Criteria for Assessing the Extent of Tumor Regression in Malignant Tumors of the Rectum

“…Local recurrences have a negative impact on the prognosis of colorectal cancer. The main and most significant anatomical and biological factors influencing the risk of local relapse are the degree of tumor germination into the rectal wall, the presence of tumor cells in the lymph nodes, the circular border of resection (circumferentialresectionmargin-CRM), vascular and perineural invasion, the degree of differentiation and the location of the tumor [2,11]. In our opinion, from the standpoint of preventing the development of local relapses and distant metastases, as well as improving survival, preoperative radio (chemo) therapy is more expedient.…”

“…Early development of local recurrences and distant metastases is a serious problem facing surgeons involved in the treatment of rectal diseases. Despite the fact that, the abdominal perineal extirpation, proposed for rectal cancer by Miles, opened a new era in the treatment of rectal cancer, the introduction of radio-and chemotherapy enabled the development of new approaches to solving this problem [2].…”

784 Clinical applications of molecular profiling of colorectal cancer

“…The increasing use of adjuvant and neoadjuvant therapy has led to improved outcomes in the management of colorectal cancer [530]. Post-operative adjuvant chemotherapy has been shown to improve the outcome in patients with Dukes' C tumours and is generally accepted as standard care [357] , however, only selected patients of Dukes' B group would benefit from this treatment.…”