Changing patterns of neoadjuvant therapy for locally advanced rectal cancer: A narrative review. (January 2023)

• Record Type: Journal Article
• Authors: He, Weijing; Li, Qingguo; Li, Xinxiang
• Is Part Of: Critical reviews in oncology/hematology. Volume 181(2023)
• Publication Date: 2023-01
• Subjects: Locally advanced rectal cancer -- Neoadjuvant chemoradiotherapy -- Waiting period -- Total neoadjuvant therapy -- Immunotherapy; Oncology -- Periodicals; Hematology -- Periodicals; 616.994
• DOI: 10.1016/j.critrevonc.2022.103885
• Languages: English
• ISSNs: 1040-8428

Abstract

Abstract: Standard treatment for patients with locally advanced rectal cancer has been the multidisciplinary approach of neoadjuvant chemoradiotherapy, followed by total mesorectal excision (TME) and postoperative adjuvant chemotherapy. This reduces the local recurrence rate, but the challenge of distant metastasis still persists. The improvement in treatment approach has always been the focus of clinical research and studies have been conducted worldwide in recent years. On one hand, evidence suggests that increasing the intensity of treatment can result in better tumor regression, for example by adding a second drug to the neoadjuvant chemoradiotherapy, or extending the interval between neoadjuvant therapy and surgery, or incorporating chemotherapy and chemoradiotherapy in the neoadjuvant setting. On the other hand, neoadjuvant immunotherapy and selective omission of neoadjuvant radiotherapy may improve the quality of life of patients. In this article, we review the key clinical research progresses in neoadjuvant therapy for locally advanced rectal cancer, hoping to provide some valuable views on the individualized treatment for rectal cancer. Highlights: ● With the development of precision medicine and individualized treatment, there are more treatment strategies for neoadjuvant therapy for patients with locally advanced rectal cancer (LACR). ● This review narrates the key clinical research progress on neoadjuvant therapy for locally advanced rectal cancer. ● For patients who have no difficulty in anal preservation but with a high risk of distant metastasis, induction chemotherapy is recommended. ● Selective omission of RT deserves careful consideration for mid-to-high located RC with low or intermediate risk of recurrence to avoid radiation toxicity. ● Immunotherapy monotherapy is promising, especially for patients with dMMR and MSI-H LARC, however, requires further confirmation from larger studies.