Tailored total neoadjuvant therapy for locally advanced rectal cancer: One size may not fit for all!

Leyla Ozer, Ibrahim Yildiz, Vedat Bayoglu, Mustafa Bozkurt, Eren Esen, Feza H. Remzi, Ismail Gogenur, Erman Aytac*

*Corresponding author for this work

Research output: Contribution to journalComment/debateResearchpeer-review

10 Citations (Scopus)

Abstract

While current neoadjuvant protocols have proven benefits on local control for majority of patients with locally advanced rectal cancer, there are certain clinical conditions that require future advances for improving the outcomes. Total neoadjuvant therapy incorporates systemic chemotherapy planned within standard neoadjuvant protocols either before or after radiotherapy for locally advanced rectal cancer as a whole. Enhanced compliance with planned oncological therapy, tumour downstaging, administration of chemotherapy at the earliest time in the disease course to help assessing chemosensitivity are the proposed benefits of total neoadjuvant therapy in patients with locally advanced rectal cancer. Patient selection criteria for administration of total neoadjuvant therapy in the recent guidelines are unclear. Since current literature is inconclusive for the optimal sequence and type of radiotherapy and chemotherapy, premature incorporation of total neoadjuvant therapy for all locally advanced rectal cancers may result in overtreatment and subsequently toxicity. This article aims to discuss the current literature and to propose a future perspective by considering real-life scenarios reflecting patients’ needs for treatment of locally advanced rectal cancer.

Original languageEnglish
JournalColorectal Disease
Volume23
Issue number7
Pages (from-to)1662-1669
Number of pages8
ISSN1462-8910
DOIs
Publication statusPublished - 2021

Bibliographical note

Publisher Copyright:
© 2021 The Association of Coloproctology of Great Britain and Ireland

Keywords

  • algorithm
  • locally advanced
  • rectal cancer
  • total neoadjuvant treatment

Cite this