Kang MK. Implications of recent neoadjuvant clinical trials on the future practice of radiotherapy in locally advanced rectal cancer. World J Gastroenterol 2023; 29(6): 1011-1025 [PMID: 36844136 DOI: 10.3748/wjg.v29.i6.1011]
Corresponding Author of This Article
Min Kyu Kang, MD, PhD, Associate Professor, Department of Radiation Oncology, Kyungpook National University Chilgok Hospital, 807 Hoguk-ro, Buk-gu, Daegu 40414, South Korea. mkkang@knu.ac.kr
Research Domain of This Article
Oncology
Article-Type of This Article
Review
Open-Access Policy of This Article
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/
World J Gastroenterol. Feb 14, 2023; 29(6): 1011-1025 Published online Feb 14, 2023. doi: 10.3748/wjg.v29.i6.1011
Implications of recent neoadjuvant clinical trials on the future practice of radiotherapy in locally advanced rectal cancer
Min Kyu Kang
Min Kyu Kang, Department of Radiation Oncology, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
Min Kyu Kang, Department of Radiation Oncology, Kyungpook National University Chilgok Hospital, Daegu 40414, South Korea
Author contributions: Kang MK is the sole author of this manuscript and is solely responsible for its content; Kang MK performed all the research and collected, analyzed, and interpreted all the data, prepared and wrote the manuscript and performed all critical revisions; Kang MK has overall responsibility for this manuscript.
Conflict-of-interest statement: There are no relevant conflicts of interest to report for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Min Kyu Kang, MD, PhD, Associate Professor, Department of Radiation Oncology, Kyungpook National University Chilgok Hospital, 807 Hoguk-ro, Buk-gu, Daegu 40414, South Korea. mkkang@knu.ac.kr
Received: November 18, 2022 Peer-review started: November 18, 2022 First decision: November 30, 2022 Revised: December 8, 2022 Accepted: January 29, 2023 Article in press: January 29, 2023 Published online: February 14, 2023
Abstract
Over the last two decades, the standard treatment for locally advanced rectal cancer (LARC) has been neoadjuvant chemoradiotherapy plus total mesorectal excision followed by adjuvant chemotherapy. Total neoadjuvant treatment (TNT) and immunotherapy are two major issues in the treatment of LARC. In the two latest phase III randomized controlled trials (RAPIDO and PRODIGE23), the TNT approach achieved higher rates of pathologic complete response and distant metastasis-free survival than conventional chemoradiotherapy. Phase I/II clinical trials have reported promising response rates to neoadjuvant (chemo)-radiotherapy combined with immunotherapy. Accordingly, the treatment paradigm for LARC is shifting toward methods that increase the oncologic outcomes and organ preservation rate. However, despite the progress of these combined modality treatment strategies for LARC, the radiotherapy details in clinical trials have not changed significantly. To guide future radiotherapy for LARC with clinical and radiobiological evidence, this study reviewed recent neoadjuvant clinical trials evaluating TNT and immunotherapy from a radiation oncologist’s perspective.
Core Tip: In locally advanced rectal cancer (LARC), recent randomized controlled trials have demonstrated the benefits of total neoadjuvant treatment (TNT) in terms of oncologic outcomes and organ preservation. The results of clinical trials of immunotherapy suggest the possibility of pelvic radiotherapy in combination with immunotherapy for LARC. However, the radiotherapy details used in clinical trials have not changed significantly. This study reviewed recent neoadjuvant clinical trials evaluating TNT and immunotherapy from a radiation oncologist’s perspective to guide future radiotherapy for LARC.
