Strategies to Optimize Treatment for Locally Advanced Rectal Cancer

SIMPLE SUMMARY: Locally advanced rectal cancer (LARC) is a group of highly heterogeneous tumors. According to the European Society for Medical Oncology (ESMO) guidelines, the risk of recurrence can be classified by magnetic resonance imaging (MRI) as low to very high. In the era of precision medicine, final treatment decisions should be based on risk stratification. Not all LARC cases are appropriate for the predominant neoadjuvant “sandwich” strategy. Treatment modalities for LARC have dramatically evolved in recent years. Multiple clinical trials focused on optimizing strategies to improve outcome oncology outcomes and functions for LARC patients. In the context of precision medicine, treatment decisions for locally advanced rectal cancer should be based on risk stratification, molecular typing, and patient preference. ABSTRACT: Neoadjuvant long-course concurrent chemoradiation plus surgery, followed by optional adjuvant chemotherapy, is a standard of care for locally advanced rectal cancer (LARC). However, this traditional approach has several limitations, including low pathological complete response (pCR) (10–25%), high metastasis rate (30–35%), and highly inconsistent compliance with adjuvant chemotherapy (25–75%). Treatment modalities for LARC have dramatically evolved in recent years. Multiple clinical trials have focused on optimizing strategies to achieve a win-win situation for oncologic outcomes and functions. Here, we review the latest studies into optimizing neoadjuvant treatment for LARC.