Vincenzo Valentini, MD

There are a number of clinicopathologic variables that predict outcome in rectal cancer. In the era of postoperative chemoradiation treatment, these were more easily identified and were used to help select patients for adjuvant therapy.

The preferred integrated treatment modality for locally advanced rectal cancer is preoperative radio(chemo)therapy followed by total mesorectal excision, though certain aspects of this standard are still debated.

The authors review the main evidence from the literature on neoadjuvant approaches in locally advanced rectal cancer, starting with the use of radiotherapy only in the pre–total mesorectal excision (TME) era, through fluorouracil (5-FU)–based chemoradiation in the TME era, to the most modern administration of “targeted therapy” in association with radiotherapy and traditional chemotherapy.