Tailoring therapy through response evaluation: A new era in the management of locally advanced rectal cancer

Abstract

Neoadjuvant chemoradiotherapy combined with surgical resection is considered standard care for locally advanced rectal cancer (LARC). Post-neoadjuvant chemoradiotherapy evaluation and tumor restaging are pivotal components of the treatment paradigm for LARC. These two components not only determine the type of subsequent treatment strategies but also provide the basis for prognosis prediction. Thus, they serve as the cornerstone for accurate and effective patient management in LARC. Currently, conventional assessment modalities, such as imaging and endoscopy evaluation, are widely utilized in clinical practice. At the same time, continuous breakthroughs in emerging technologies, such as circulating tumor DNA detection, multi-omics techniques, artificial intelligence-assisted decision-making, intestinal flora, and patient-derived organoids, provide new perspectives on restaging in LARC, which is expected to make up for the limitations of traditional methods. Additionally, novel therapeutic modalities, such as total neoadjuvant therapy, immune checkpoint inhibitors, and watch-and-wait strategies, impose higher demands for accurate treatment response evaluation and restaging. An in-depth review and discussion of the relevant assessment methods, optimal timing, standardized strategies, and cutting-edge advances hold significant clinical relevance and scientific value in the treatment of LARC. Specifically, it may improve the clinical diagnosis and treatment of LARC, optimize individualized therapeutic decision-making, and improve the prognosis of patients.

Keywords: Rectal cancer; Neoadjuvant therapy; Response evaluation; Tumor restaging; Minireview

Core Tip: Neoadjuvant chemoradiotherapy followed by surgery is the standard treatment for locally advanced rectal cancer. Accurate post-treatment evaluation and restaging are crucial to guide subsequent treatment and prognosis prediction. While conventional methods such as imaging and endoscopy are widely used, their application is hampered by several limitations. Emerging technologies such as detection of circulating tumor DNA, multi-omics, and artificial intelligence offer new perspectives for cancer restaging. Novel therapies such as total neoadjuvant therapy and watch-and wait strategies require enhanced precision in response assessment to optimize individualized therapeutic decisions and improve prognosis in patients with locally advanced rectal cancer.