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Colorectal cancer is the third most common malignancy by incidence and remains a leading cause of cancer-related mortality. Surgical resection remains the cornerstone of curative-intent treatment for rectal cancer. For patients with locally advanced or node-positive tumours (cT3/4, N+), multimodal therapy involving chemoradiation, surgery and systemic therapy is critical to minimise the risk of local and systemic recurrence.
The management of rectal cancer has evolved over the past several decades from a surgery-alone approach, to surgery followed by adjuvant chemoradiation, to a neoadjuvant chemoradiation strategy. Postoperative combined-modality therapy was initially supported by randomised trials from the Gastrointestinal Tumor Study Group and Mayo/North Central Cancer Treatment Group which demonstrated improved local recurrence and survival compared with surgery alone.1 2 With this evidence, the historical 1990 National Cancer Institute guidelines recommended postoperative combined-modality radiation for patients with stage II and III rectal cancer. However, given the potential effects of postoperative radiation on late complications including wound healing and bowel function, there was a growing interest in identifying high-risk patients suitable for a neoadjuvant approach. The impact of preoperative radiation therapy on improved local relapse was initially supported by the Swedish Rectal Cancer Trial.3 …
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