MODERN PRINCIPLES OF NEOADJUVANT CHEMOTHERAPY IN LOW RECTAL CANCER
Keywords:
Neoadjuvant chemotherapy; low rectal cancer; chemoradiotherapy; FOLFOX; CAPOX; total neoadjuvant therapy (TNT); tumor regression; sphincter preservation; targeted therapy; immunotherapy; personalized medicine; multimodal treatment; colorectal oncology.Abstract
Low rectal cancer remains one of the most challenging malignancies in modern oncology due to its complex anatomical location, the risk of local recurrence, and the necessity to preserve sphincter function. The development of neoadjuvant chemotherapy has fundamentally changed the approach to treating these tumors, improving both oncological and functional outcomes. The main objective of neoadjuvant therapy is to achieve tumor downstaging, reduce micrometastatic spread, and increase the likelihood of complete surgical resection (R0 resection).
In recent years, several chemotherapy regimens, including FOLFOX (5-fluorouracil, leucovorin, and oxaliplatin) and CAPOX (capecitabine and oxaliplatin), have demonstrated significant effectiveness when used either alone or in combination with radiotherapy. The integration of these systemic therapies into multimodal treatment protocols has led to better local tumor control, improved overall survival, and a higher rate of organ preservation.
Furthermore, the use of total neoadjuvant therapy (TNT), which incorporates both systemic chemotherapy and chemoradiotherapy prior to surgery, has shown superior pathological complete response rates. The introduction of molecular diagnostics and biomarker-based treatment selection has opened new opportunities for personalized medicine in rectal cancer, including the use of targeted and immune therapies.
This paper analyzes the current principles, strategies, and results of neoadjuvant chemotherapy in low rectal cancer and discusses emerging trends that could shape future treatment protocols aimed at optimizing efficacy while minimizing adverse effects.
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