Therapeutic Advances in Rectal Cancer.

BACKGROUND

Inferior rectal cancer, a malignancy occurring in the lower portion of the rectum, represents a significant clinical challenge due to its complex anatomical location and the diverse treatment approaches required for optimal patient outcomes. Over the past few decades, advancements in surgical techniques, radiotherapy, and systemic treatments have contributed to improving survival rates and minimizing morbidity associated with this disease.

AREAS OF UNCERTAINTY: Neoadjuvant therapy combined with tumor resection surgery has demonstrated significant improvements in survival in patients with rectal cancer. However, uncertainty persists due to variability in therapeutic responses among different groups of patients and the limited availability of long-term data on the efficacy of pathologic responses. These limitations affirm the need for further studies to optimize and personalize the therapeutic approach to rectal cancer.

DATA SOURCES: A search for information was conducted using recognized databases, including Cochrane, PubMed, Scielo, ScienceDirect, and Scopus. The search strategy was designed using specific terms such as: "rectal neoplasms" OR ("rectal AND neoplasms") OR "rectal cancer" AND ("therapeutics" OR "treatments"), to identify relevant publications.

THERAPEUTIC ADVANCES: Minimally invasive techniques offer oncologic outcomes equivalent to open surgery with faster recovery and lower morbidity, supported by total neoadjuvant therapy, which has become the standard of care for locally advanced rectal cancer, achieving higher pathologic complete response rates (OR 2.44, 95% CI, 1.99-2.98) and longer disease-free survival (OR 2.07, 95% CI, 1.20-3.56) than conventional chemoradiotherapy. In addition, emerging targeted agents (VEGF and EGFR inhibitors) in molecularly selected patients and PD-1 blockade in dMMR tumors further improve response rates and support organ preservation strategies.

CONCLUSIONS

Despite notable advances in treatment strategies for rectal cancer, challenges remain in identifying a therapeutic modality that can improve both overall survival and disease-free survival without exposing the patient to overly aggressive interventions.