Novel Radiation Approaches for the Treatment of Rectal Cancer: Where Are We Now?

Over the past decade, significant strides have been made in improving local control for stage II and III rectal cancer, including the use of neoadjuvant chemoradiation and total mesorectal excision. These advancements have led to a remarkable 10-year local failure rate of just 7.1 %. This has come, however, at the cost of moderate treatment-related morbidity, emphasizing a need for further refinement of management strategies. This article will explore recent innovations and novel approaches involving radiation therapy to address these issues, including the use of intensity-modulated radiation therapy, avoidance of radical resection with the use of chemoradiation alone, total neoadjuvant chemotherapy with the selective use of chemoradiation, and the use of local excision approaches following neoadjuvant treatment. Although many of these novel strategies appear promising, data from prospective randomized trials will be necessary before implementation into standard practice.