New Neoadjuvant Treatment Strategies for Non-Metastatic Rectal Cancer (M0)

Rectal cancers stages II-III are presenting many various clinical situations. Neoadjuvant chemoradiotherapy is a standard of care in many cases, and in association with TME surgery, local relapses are becoming uncommon. None of these neoadjuvant treatments have so far improved survival, and quality of life remains non-optimal after abdominoperineal resection and quite often after anterior resection. To increase survival through sterilization of subclinical distant metastases, new induction chemotherapy is tested. In T4 tumors, radiation dose escalation should be able to further improve local control, and in elderly patients, reduction of nCRT toxicity may provide better compliance to TME surgery. A promising approach is the use of optimal neoadjuvant treatment in early tumors in order to achieve a clinical complete response and propose an organ preservation either after local excision or using a meticulous and prolonged watch and wait strategy. Well-conducted randomized trials will be necessary to modify the present standard of care.