Neoadjuvant Chemoradiotherapy and Neoadjuvant Chemotherapy
Rectal cancer is a challenging disease to treat, and its optimal management requires a multidisciplinary approach with involvement of surgical, medical, and radiation oncologists.
The significant advancements in the surgical techniques, preoperative treatment, and medical imaging technology have altered the therapeutic landscape and led to substantial improvements in both local disease control and patient survival. Currently, preoperative (neoadjuvant) chemoradiation (chemoradiotherapy; CRT) is the established standard of care for patients with locally advanced rectal cancer. This treatment paradigm consists of concurrent radiotherapy and infusional-5-FU- or oral capecitabine-based chemotherapy, followed by recovery time, and then total mesorectal excision (TME). Sometimes adjuvant chemotherapy follows surgery. Despite the therapeutic benefits and excellent local control achieved with such a treatment model, CRT remains associated with significant side effects. Therefore, potential practice changing trials are currently ongoing to put forth a new treatment strategy that will enable us to better select patients and deliver the precise therapy for that particular individual, aiming at changing the old concept of “one size fits all” to a new one of “custom-made therapy.” A more tailored approach to therapy allows for adaptive therapies based on individual patients and their treatment response, whether this response is to neoadjuvant chemotherapy alone or induction chemotherapy followed by chemoradiation. The results of these ongoing efforts could result in a paradigm shift and an ideal tailored approach to the management of rectal cancer.
The focus of this chapter is to highlight the scientific evidence for managing locally advanced rectal cancer using preoperative CRT, discuss how this treatment has evolved to become the current standard of care, and address the future treatment of this disease.
KeywordsRectal cancer Neoadjuvant chemotherapy Neoadjuvant chemoradiotherapy
We would like to thank Marion L. Hartley, Ph.D., for her editing assistance.
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