Neoadjuvant therapy for rectal cancer

The purpose of neoadjuvant therapy is to increase the resection rate, improve the anal preservation rate and prolong the disease-free survival of patients. Neoadjuvant chemoradiotherapy is recommended only for rectal cancer <10cm.

1. Fluorouracil based neoadjuvant chemotherapy is recommended for preoperative treatment of rectal cancer.

2. Direct operation is recommended for patients with T1-2N0M0 or contraindications of chemoradiotherapy, and neoadjuvant therapy is not recommended.

3.Preoperative neoadjuvant chemoradiotherapy is recommended in principle for patients with resectable rectal cancer of 3, T3 and/or N+, and neoadjuvant chemoradiotherapy alone can also be considered after discussion of MDT, and then combined chemotherapy or not can be decided according to efficacy evaluation.

4.T4 or locally advanced unresectable rectal cancer patients must undergo preoperative chemoradiotherapy. After treatment, the MDT must be re-evaluated to discuss whether surgery is feasible. For neoadjuvant chemoradiotherapy, capecitabine monotherapy or continuous infusion of 5-FU or 5-FU/LV is recommended as the preferred chemotherapy regimen, and chemotherapy is performed simultaneously during long-term radiotherapy.

5. For patients who are not suitable for radiotherapy, it is recommended to decide whether to perform neoadjuvant chemotherapy alone under MDT discussion.