Abstract
Postoperative adjuvant chemoradiotherapy was recommended as the standard treatment for patients with rectal cancer because it reduces local recurrence. This paradigm shifted with the use of neoadjuvant chemoradiotherapy, which not only reduces local recurrence but also improves sphincter preservation and surgical outcomes. However, the treatment of rectal carcinoma remains complicated. The accuracy of tumor staging can be compromised depending on the imaging modality used. The addition of modern chemotherapeutics and biologics to 5-fluorouracil as radiation sensitizers is questionable. Oxaliplatin as a radiation sensitizer has minimal effects on the pathologic complete response, but improves the radiographical response at the expense of an increased risk of toxicities. The role of biologics in addition to radiation therapy continues to be explored. Attention has focused on improving diagnostic imaging, radiation oncology, and surgical techniques, treatment regimens, and on exploring a role of molecular markers for patients with rectal cancers. We review the pivotal trials that have led to the current treatment paradigm for locally advanced rectal cancer and discuss novel methodologies that are being developed for the treatment of this prevalent malignancy.
Key Points
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Preoperative chemoradiotherapy, followed by surgery and subsequent adjuvant chemotherapy, provides the best local disease control, sphincter preservation, and surgical outcomes in locally advanced rectal cancer (LARC)
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Modern therapeutics, acting as radiation sensitizers, provide alternatives to the standard treatment with single agent 5-fluorouracil
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Current limitations in approved chemotherapeutic agents such as oxaliplatin have led to an increased emphasis on improvements in diagnostic imaging, radiation oncology, surgical techniques, molecular markers, and treatment schema
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Ongoing clinical trials explore new combinations of multimodality therapy that might enhance tumor regression, increase overall survival, and improve quality of life for patients with LARC
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Continued attempts to research and modify the current treatment paradigm are necessary to advance new developments in the treatment of rectal cancer
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C. P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape, LLC-accredited continuing medical education activity associated with this article.
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Aklilu, M., Eng, C. The current landscape of locally advanced rectal cancer. Nat Rev Clin Oncol 8, 649–659 (2011). https://doi.org/10.1038/nrclinonc.2011.118
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