D.V. Kuzmichev, A.V. Polynovskiy, A.A. Aniskin, V.A. Aliev, D.V. Aleksantsev, A.S. Gorbunova

N.N. Blokhin National Medical Research Center of Oncology, Moscow

Kuzmichev Dmitriy V. — Doct. of Sci. (Med.), Senior Researcher at the Department of Abdominal Oncology №3 (Coloproctology) of the N.N. Blokhin National Medical Research Center of Oncology

23 Kashirskoe highway, Moscow 115522, Russian Federation, tel. +7-905-790-70-05, e-mail:, ORCID ID: 0000-0002-8129-5394

Abstract. In this review, we highlight all the major stages in management of locally advanced rectal cancer (LARC). We present the studies that supported the sequence of treatment from surgery to radiation, chemotherapy and chemoradiotherapy (CRT). Progress in the treatment of patients with LARС has shifted the focus to the use of total neoadjuvant therapy (TNT) and immunotherapy. The main feature of using TNT, from the standard care, is providing early systemic treatment, facilitating early targeting of micrometastatic disease and eliminates the need for postoperative chemotherapy. Recent studies demonstrate great results of immunotherapy in achieving «pathological complete response» (pCR) in MSI-H tumors, which can provide «watch and wait» approach. Evolution of contemporary methods of LARC treatment have significantly increased the survival rates and quality of life, such a difficult category of patients.

Key words: local advanced rectal cancer, combined treatment of locally advanced rectal cancer, total neoadjuvant therapy of locally advanced rectal cancer; immunotherapy of locally advanced rectal cancer.