Оverview of discussions and decision-making on total neoadjuvant therapy of distal rectal cancer

Abstract

Advances implemented in the complex treatment of distal rectal cancer led to a decrease in the number of loco-regional recurrences to 5–10%, but high rates of distant metastases remain at up to 30%. They lead to disappointing long-term oncological results, which requires the search for improvement of each of the stages of complex treatment. As a consequence of the questionable effectiveness of adjuvant polychemotherapy for distal rectal cancer, the question of the possibility of transferring drug treatment from an adju vant to a neoadjuvant regimen is reasonably raised. The presented options for full neoadjuvant therapy have been developed and tested in leading oncology centers and are based on National Comprehensive Cancer Network Version 1.2022 recommendations. It is premature to make categorical conclusions regarding the recommendation of one or another variant of their implementa tion. Our preliminary clinical results confirmed the need for an additional stage of restaging in the second option, after 16 weeks of polychemotherapy before chemoradiation, in order to exclude the generalization of the disease. Therefore, there is a need for a prospective, controlled intercentre study to answer some unresolved questions.