Short-course radiotherapy as part of total neoadjuvant therapy for locally advanced rectal cancer – a new standard?

Abstract

Selection of optimal perioperative treatment for rectal cancer remains a subject of controversy. Recently established new rationales for the use of short-course preoperative radiotherapy (SCRT – 25 Gy in 5 fractions), instead of standard long-course preoperative radio-chemotherapy (LCRT-CT), are presented and discussed in the present review. New data suggest that short-course radiotherapy combined with 6 cycles of CAPOX, or 9 of FOLFOX4, at present may be considered the best option for perioperative treatment of high-risk rectal cancer. However, there is a clear need to further optimize preoperative treatment using rapidly evolving markers of treatment response, including microsatellite instability and targetable or predictive tumour mutations.