Rectal Cancer: Neoadjuvant Therapy

Over the last half century, there has been tremendous evolution in the treatment of rectal cancer, and the pace of change is increasing. This chapter will provide some insight into how we arrived at our current treatment algorithms and what the future may hold. First, it will review the history of the trials that have led us to our current standard of care, trimodal therapy with radiation, surgery, and chemotherapy. In this account, some of the more controversial aspects of treatment will be discussed, including short verses long-course radiotherapy. In an effort to shorten the delay to when a patient ultimately receives chemotherapy, improve compliance with therapy, and theoretically improve outcomes, the pendulum has swung toward total neoadjuvant therapy (TNT), where radiation and chemotherapy are delivered prior to surgery. The studies supporting this approach will be discussed, as well as ongoing trials that will certainly affect how we treat rectal cancer patients moving forward.