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J.Jpn. Surg. Soc.. 122(4): 379-385, 2021
PREOPERATIVE TREATMENT FOR LOCALLY ADVANCED RECTAL CANCER:RADIOTHERAPY, CHEMORADIOTHERAPY, NEOADJUVANT CHEMOTHERAPY, AND TOTAL NEOADJUVANT THERAPY
In Japan, the standard therapy for locally advanced rectal cancer is total mesorectal excision (TME) ＋ lateral lymph node dissection, with subsequent postoperative adjuvant chemotherapy only for pathological stage Ⅲ. Thus, preoperative treatment is not generally administered. On the other hand, in Western countries where lateral lymph node dissection is not performed, preoperative radiotherapy (RT) followed by TME has been widely performed for rectal cancer since the 1980s, and after numerous clinical trials, preoperative chemoradiotherapy or preoperative short-course RT is now the standard treatment. Although these preoperative treatments are considered to be beneficial for local control, they do not improve overall survival. Meanwhile, in recent years in Europe and the USA, “watch-and-wait” therapy, which avoids surgery if preoperative therapy provides a clinical complete response, and total neoadjuvant therapy, which involves both radiotherapy and systemic chemotherapy, have emerged as treatment options. Improved overall survival with preoperative treatment can now be expected. These new therapies are described in both the National Comprehensive Cancer Network and European Society for Medical Oncology guidelines. As personalized medicine is currently being called for, Japanese surgeons should be familiar with various treatment options for rectal cancer.
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