Have we put the cart before the horse? Reordering treatments for rectal cancer

摘要

Total neoadjuvant treatment of rectal cancer - the concept of administering all cycles of systemic chemotherapy followed by radiation with concurrent fiuo-ropyrimidine prior to surgical resection - has been evaluated in Phase II studies. Is there adequate data to consider this approach an acceptable standard of care? Can we use total neoadjuvant treatment as the new model to incorporate targeted agents, or must we await what would unquestionably be a dull, tedious and inexorably long Phase III trial comparing preoperative versus postoperative systemic chemotherapy.