Total neoadjuvant therapy for rectal cancer

The established standard of care in the treatment of locally advanced rectal cancer is trimodal therapy with neoadjuvant radiation, surgery and adjuvant chemotherapy. While the data supporting neoadjuvant radiation and surgery is well founded, there is little to no evidence that shows a benefit from adjuvant chemotherapy. The majority of cancer related deaths from rectal cancer are due to distant metastatic disease. Extrapolation from colon cancer data and small studies suggest that earlier administration of chemotherapy may improve outcomes. This article provides the background and theoretical arguments for the delivery of chemotherapy in the neoadjuvant setting. It will discuss early results, longer term outcomes, and future directions of neoadjuvant chemotherapy for locally advanced rectal cancer.