Comprehensive Treatment of Rectal Cancer

Dear Colleagues,

Colorectal cancer (CRC) is a significant healthcare burden worldwide.

Globocam estimates the burden of CRC will increase to 3.2 million new cases and 1.6 million deaths by 2040. Treating locally advanced diseases, especially those in the rectum, is subject to debate. Traditionally, surgical resection has been the cornerstone of treatment for rectal cancer. However, the treatment paradigm has evolved in these years. In 2000, a meta-analysis showed that preoperative radiotherapy significantly improved overall survival (OS) compared with surgery alone, leading to the widespread adoption of this approach as a standard treatment. Also, it is proved that therapeutic effects can be ameliorated by associating chemotherapy with radiotherapy. The goals of chemoradiotherapy in rectal cancer should increase the results obtained with radiotherapy (downstage the tumour, the likelihood of sphincter preservation, and local tumour control) and reduce the risk of distant metastasis and more impacting (OS) outcomes. Surgical techniques had also evolved to improve the outcomes of these patients, although only recently these improvement are been standardized. Introducing the total mesorectal excision (TME) technique dramatically improved local recurrence-free survival.

The gold-standard treatment is a neoadjuvant approach with long term radiotherapy, fluoropyrimidine, and TME surgery. With the golden standard treatment, less than 5% of patients will have a local recurrence disease, but a stable rate of patients will have distant metastasis, with data at five years of 32%. Even today, the optimal management of rectal cancer remains a subject of ongoing research. Especially several attempts were made to evaluate the impact of chemotherapy-only treatment to reduce side effects on disease free survival (DFS) and OS. To this it is added the microsatellite instability-high locally advanced rectal cancer and the combination of immune checkpoint inhibitors with preoperative chemoradiotherapy. Considering all and thinking about the landscape of systemic treatments in the following years, an accurate estimate of DFS and OS rates in this group of patients is essential. Changing the natural history of rectal cancer is the only way to increase survival. 

This Special Issue of the Journal aims to comprehensively evaluate the developments in locally advanced rectal cancer treatment (surgery, radiotherapy, chemotherapy, immunotherapy) in order to optimize treatment strategies and improve long-term survival outcomes in these patients through to the collaboration of the specialists involved in rectal cancer treatment.

Dr. Jacopo Giuliani
Guest Editor

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• rectal cancer
• surgery
• chemoradiotherapy
• neoadjuvant therapy
• radiotherapy
• chemotherapy
• microsatellite instability-high
• immunotherapy