Modern principles of neoadjuvant therapy for rectal cancer

Objective. The location of the rectum in the space limited by the rigid frame of the pelvic bones has determined the priority of combined modality treatment for locally advanced rectal cancer with a significant role of preoperative therapy. Over the past three decades, radiation therapy has become an increasingly integral component of neoadjuvant treatment of rectal cancer. Research activities aimed at increasing the effectiveness of perioperative radiotherapy in preventing local recurrence have been ongoing. Material and Methods. This article provides an overview of the results of current studies of various neoadjuvant therapy regimens for locally advanced rectal cancer, as well as promising options for optimizing preoperative irradiation. The search for publications on the topic of the review was performed using the Web of Science and PubMed databases. Out of 202 studies, 36 were selected for literature review. Results. The question of the advantage of large fraction radiotherapy over prolonged chemoradiotherapy still remains open. Improvements in neoadjuvant treatment outcomes in rectal cancer are associated with various options for increasing the radiation dose. In addition, the review examines the use of preoperative chemotherapy as an alternative to radiation therapy or as a component of combined modality treatment for rectal cancer. Conclusion. It is assumed that the strategy of total neoadjuvant therapy will not only improve local disease control, but also reduce the risks of systemic relapse. Currently, a multidisciplinary approach is of great importance in optimizing the treatment strategy for patients with rectal cancer.