Total neoadjuvant therapy is a current trend in the treatment of locally advanced rectal cancer

Introduction. Radiation therapy, which has long been a standard element of the neoadjuvant stage of combined treatment of locally advanced rectal cancer, has made significant progress in preventing local recurrence of the disease. The desire to improve the efficiency of local control, as well as to influence the risks of systemic relapse, led to the development of the concept of total neoadjuvant therapy.Results. The article is a review of modern publications analyzing the results of the use of total neoadjuvant therapy. A number of recent randomized clinical trials have demonstrated the effectiveness of this approach, achieving an improvement in disease-free and overall survival, and a reduction in the incidence of distant metastasis of rectal cancer. At the same time, no negative impact of neoadjuvant chemotherapy on the frequency of radical resection, the quality of total mesorectumectomy, or the structure of postoperative complications was recorded. Similar results were noted in a number of published meta-analyses examining the effectiveness and safety of total neoadjuvant therapy.Conclusions. The combination of radiation therapy and systemic chemotherapy in the preoperative period offers hope for improving the results of treatment of locally advanced rectal cancer. Indications for total neoadjuvant therapy, the optimal regimen and frequency of chemotherapy cycles currently still need to be clarified.