Neoadjuvant Short- Vs. Long-Course Radiation for Locally Advanced Rectal Cancer: How to Choose

• Published in: Current treatment options in oncology Vol. 25; no. 4; pp. 427 - 433
• Main Authors: Willett, Christopher G., Acklin-Wehnert, Scarlett
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.04.2024; Springer Nature B.V
• Subjects: Cancer therapies; Chemoradiotherapy; Chemoradiotherapy - methods; Chemotherapy; Clinical trials; Colorectal cancer; Combined Modality Therapy; Compliance; Disease control; Humans; Lymphatic system; Medicine; Medicine & Public Health; Metastasis; Neoadjuvant Therapy - methods; Neoplasm Recurrence, Local - drug therapy; Neoplasms, Second Primary; Oncology; Radiation therapy; Rectal Neoplasms - diagnosis; Rectal Neoplasms - radiotherapy; Rectal Neoplasms - surgery; Rectum; Topical Collection on Lower Gastrointestinal Cancers; Toxicity; Treatment Outcome; Tumors; Total neoadjuvant treatment; Locally advanced rectal cancer; Radiotherapy; Chemoradiation; Neoadjuvant treatment
• ISSN: 1527-2729; 1534-6277; 1534-6277
• DOI: 10.1007/s11864-024-01185-5

Opinion statement Over the past decades, the treatment of locally advanced rectal cancer has evolved dramatically due to improvements in diagnostic imaging, surgical technique, and the addition of radiotherapy and/or chemotherapy. Fractionation of neoadjuvant radiotherapy with or without concurrent chemotherapy remains the subject of discussion and the question multiple recent trials have aimed to answer. In light of recent data and concern for locoregional recurrence, our institution favors long-course chemoradiation in most cases, especially in low-lying primaries, threatened circumferential resection margin, consideration of non-operative management, or if the surgeon has concerns for resectability. Exceptions would include cases of oligometastatic disease planned for metastasectomy in which curative-intent treatment was pursued or if additional factors required a reduction in treatment time.