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Review
. 2024 May 8;8(3):zrae038.
doi: 10.1093/bjsopen/zrae038.

Neoadjuvant treatment of colorectal cancer: comprehensive review

Henry G Smith  1 , Per J Nilsson  2 , Benjamin D Shogan  3 , Deena Harji  4 , Maria Antonietta Gambacorta  5   6 , Angela Romano  5 , Andreas Brandl  7 , Camilla Qvortrup  8
Affiliations
Review

Neoadjuvant treatment of colorectal cancer: comprehensive review

Henry G Smith et al. BJS Open. .

Abstract

Background: Neoadjuvant therapy has an established role in the treatment of patients with colorectal cancer. However, its role continues to evolve due to both advances in the available treatment modalities, and refinements in the indications for neoadjuvant treatment and subsequent surgery.

Methods: A narrative review of the most recent relevant literature was conducted.

Results: Short-course radiotherapy and long-course chemoradiotherapy have an established role in improving local but not systemic disease control in patients with rectal cancer. Total neoadjuvant therapy offers advantages over short-course radiotherapy and long-course chemoradiotherapy, not only in terms of increased local response but also in reducing the risk of systemic relapses. Non-operative management is increasingly preferred to surgery in patients with rectal cancer and clinical complete responses but is still associated with some negative impacts on functional outcomes. Neoadjuvant chemotherapy may be of some benefit in patients with locally advanced colon cancer with proficient mismatch repair, although patient selection is a major challenge. Neoadjuvant immunotherapy in patients with deficient mismatch repair cancers in the colon or rectum is altering the treatment paradigm for these patients.

Conclusion: Neoadjuvant treatments for patients with colon or rectal cancers continue to evolve, increasing the complexity of decision-making for patients and clinicians alike. This review describes the current guidance and most recent developments.

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Figures

Fig. 1
Fig. 1
The total neoadjuvant therapy regimens used in the RAPIDO, PRODIGE 23, STELLAR and OPRA trials Exp, experimental arm; Con, control arm; RT, short-course radiotherapy; CRT, long-course chemoradiotherapy. Patients with clinical complete or near-complete responses in the OPRA trial were offered non-operative management (NOM) as an alternative to surgery. NOM was also offered to patients with clinical complete response in the STELLAR trial.
Fig. 2
Fig. 2
The treatment regimens used in the PRODIGE 22, FOxTROT and NEOCOL trials Exp, experimental arm; Con, control arm.
See this image and copyright information in PMC

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