Locally advanced rectal cancer (LARC) remains a major clinical challenge due to its high risk of local recurrence and distant metastasis. Although total mesorectal excision (TME) has been established as the gold standard surgical approach, high recurrence rates associated with surgery alone have driven the development of multimodal preoperative strategies, such as radiotherapy and chemoradiotherapy. More recently, total neoadjuvant therapy (TNT)—which integrates systemic chemotherapy and radiotherapy prior to surgery—and non-operative management (NOM) for patients who achieve a clinical complete response (cCR) have further expanded treatment options. These advances aim not only to improve oncologic outcomes but also to enhance quality of life (QOL) by reducing long-term morbidity and preserving organ function. However, several unresolved issues persist, including the optimal sequencing of therapies, precise risk stratification, accurate evaluation of treatment response, and effective surveillance protocols for NOM. The advent of molecular biomarkers, next-generation sequencing, and artificial intelligence (AI) presents new opportunities for individualized treatment and more accurate prognostication. This narrative review provides a comprehensive overview of the current status of preoperative treatment for LARC, critically examines emerging strategies and their supporting evidence, and discusses future directions to optimize both oncological and patient-centered outcomes. By integrating clinical, molecular, and technological advances, the management of rectal cancer is moving toward truly personalized medicine.
局部进展期直肠癌因其局部复发和远处转移的高风险，仍是临床治疗的主要挑战。尽管全直肠系膜切除术已被确立为根治性手术的金标准，但单纯手术的高复发率推动了多模式术前治疗策略的发展，如放疗和放化疗。近年来，全疗程新辅助治疗（即在术前联合全身化疗与放疗）以及对达到临床完全缓解的患者采取非手术治疗策略，进一步拓展了治疗选择。这些进展不仅旨在改善肿瘤学结局，还通过减少长期并发症和保留器官功能来提高患者生活质量。然而，若干问题仍有待解决，包括最佳治疗顺序、精准风险分层、治疗反应的准确评估以及非手术治疗的有效监测方案。分子生物标志物、新一代测序技术和人工智能的出现，为个体化治疗和更精准的预后判断提供了新机遇。本文综述全面概述了局部进展期直肠癌术前治疗的现状，批判性探讨了新兴策略及其循证依据，并展望了优化肿瘤学结局和以患者为中心的治疗效果的发展方向。通过整合临床、分子及技术进展，直肠癌的治疗正朝着真正个体化医疗的方向迈进。
Neoadjuvant Treatment for Locally Advanced Rectal Cancer: Current Status and Future Directions
肿瘤(癌症)患者之家