Locally Advanced Rectal Cancer Neoadjuvant Treatment Modalities

Rectal cancer constitutes an important part of oncological diseases among patients and quite often becomes the cause of death. In our country from 2008 to 2017, the incidence of this disease has been increasing, according to the data of 2017, it is the fifth place in women, while in fourth place men. During this period methods of treatment were also gradually improved, and the better disease-related survival is associated with the introduction of multi-modal approach. However, the main problem remains that in most cases rectal cancer is diagnosed when it’s locally advanced and the treatment is relatively complicated and problematic. At present treatment of LARC consists of several steps: preoperative chemoradiotheray, radical transabdominal surgery and postoperative chemotherapy. Although such multi-modal approach reduced the local recurrence data, the issue remains problematic. Higher doses than 50.4 Gy would cause local recurrence decrease, but such kind of treatment is related to acute high-grade toxicity, increased morbidity and worsened quality of life. All this is possible with neoadjuvant volumetric modulated arc radiotherapy with simultaneous integrated boost technique, but in the review of literary sources, it has been revealed that there is no clear data about the efficacy of this technique.