Review
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Oct 15, 2016; 8(10): 715-724
Published online Oct 15, 2016. doi: 10.4251/wjgo.v8.i10.715
Current debate in the oncologic management of rectal cancer
Trish Millard, Paul R Kunk, Erika Ramsdale, Osama E Rahma
Trish Millard, Paul R Kunk, Erika Ramsdale, Division of Hematology-Oncology, Department of Medicine, University of Virginia Health System, Charlottesville, VA 22908, United States
Osama E Rahma, Center for Immuno-Oncology/GI Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, United States
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial disclosure.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Osama E Rahma, MD, Assistant Professor, Center for Immuno-Oncology/GI Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, M1B13, Boston, MA 02215, United States. osamae_rahma@dfci.harvard.edu
Telephone: +1-617-6326954 Fax: +1-617-5827227
Received: March 26, 2016
Peer-review started: March 27, 2016
First decision: May 17, 2016
Revised: July 1, 2016
Accepted: August 27, 2016
Article in press: August 29, 2016
Published online: October 15, 2016
Abstract

Despite the considerable amount of research in the field, the management of locally advanced rectal cancer remains a subject to debate. To date, effective treatment centers on surgical resection with the standard approach of total mesorectal resection. Radiation therapy and chemotherapy have been incorporated in order to decrease local and systemic recurrence. While it is accepted that a multimodality treatment regimen is indicated, there remains significant debate for how best to accomplish this in regards to order, dosing, and choice of agents. Preoperative radiation is the standard of care, yet remains debated with the option for chemoradiation, short course radiation, and even ongoing studies looking at the possibility of leaving radiation out altogether. Chemotherapy was traditionally incorporated in the adjuvant setting, but recent reports suggest the possibility of improved efficacy and tolerance when given upfront. In this review, the major studies in the management of locally advanced rectal cancer will be discussed. In addition, future directions will be considered such as the role of immunotherapy and ongoing trials looking at timing of chemotherapy, inclusion of radiation, and non-operative management.

Keywords: Chemoradiation, Immunotherapy, Non-operative management, Neoadjuvant chemotherapy, Rectal cancer

Core tip: Numerous controversies exist within the treatment of locally advanced rectal cancer. This review article summarizes the relevant evidence for rectal cancer treatment and offers opinions on how to interpret the data in clinical practice. Additional information is provided on novel areas of interest that are being actively explored such as the role of immunotherapy, the need for biomarkers, and the non-operative management.