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Rectal Cancer: Neoadjuvant Therapy

  • Andrea Cercek
  • Julio Garcia-AguilarEmail author
Chapter

Abstract

Neoadjuvant therapy is a critical component of the multidisciplinary treatment of patients with rectal cancer. The objective of neoadjuvant therapy, either radiotherapy, combined chemoradiotherapy, or chemotherapy alone, is to reduce the risk of local recurrence in patients with locally advanced rectal cancer undergoing surgical resection. But neoadjuvant therapy provides other potential advantages to rectal cancer patients. It allows early assessment of tumor responsiveness to therapy, which is closely correlated with long-term oncologic outcomes. In addition, neoadjuvant therapy could potentially enable the consideration of organ preservation by allowing for more effective local excision and nonoperative management strategies. Finally, delivering systemic chemotherapy before surgery in patients at risk for distant metastasis has the potential to improve survival by addressing micrometastatic disease earlier and improving treatment compliance. Maximizing neoadjuvant treatment response can therefore have a profound effect on both oncologic and quality-of-life outcomes. In this chapter, we will focus primarily on neoadjuvant therapy for locally advanced rectal cancer (LARC), widely accepted to be clinical stage II (cT3–T4, cN0) or stage III (any cT, cN1–N2) invasive adenocarcinomas of the rectum. We will review various treatment paradigms and the data supporting each.

Keywords

Rectal cancer Locally advanced rectal cancer Total mesorectal excision Radiation Adjuvant chemotherapy Radiation therapy Total neoadjuvant therapy PROSPECT trial Nonoperative management 

Copyright information

© ASCRS (American Society of Colon and Rectal Surgeons) 2019

Authors and Affiliations

  1. 1.Department of MedicineMemorial Sloan Kettering Cancer CenterNew YorkUSA
  2. 2.Department of SurgeryMemorial Sloan Kettering Cancer CenterNew YorkUSA

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