Locally advanced rectal cancer: Current and future perioperative treatment strategies

Background Strategies in the perioperative treatment of locally advanced rectal cancer are currently changing significantly. Results The "one-treatment-fits-all" approach of neoadjuvant radio(chemo)therapy followed by surgery and optional adjuvant therapy is increasingly being abandoned in favor of prolonged neoadjuvant chemotherapy in the sense of the so-called total neoadjuvant therapy (TNT), omission of radiotherapy for patients at low risk of local recurrence or a watch-and-wait strategy or organ preservation in case of complete clinical remission after radiochemotherapy. Conclusion The primary focus of this article is to describe the current state of the art and discuss the TNT strategy and the omission of radiotherapy on the basis of current data. In accordance with the guidelines, neoadjuvant radio(chemo)therapy can be omitted in patients with rectal cancer in which a quality-assured MRI shows a low risk for local recurrence and immediate total mesorectal excision surgery is indicated.