WJG World Journal of Gastroenterology Submit a Manuscript: https://www.f6publishing.com World J Gastroenterol 2019 September 7; 25(33): 4850-4869 DOI: 10.3748/wjg.v25.i33.4850 ISSN 1007-9327 (print) ISSN 2219-2840 (online) MINIREVIEWS Neoadjuvant radiotherapy for rectal cancer management Gerard Feeney, Rishabh Sehgal, Margaret Sheehan, Aisling Hogan, Mark Regan, Myles Joyce, Michael Kerin ORCID number: Gerard Feeney (0000-0002-1527-793X); Rishabh Sehgal (0000-0002-1905-3378); Margaret Sheehan (0000-0001-5475-392X); Aisling Hogan (0000-0002-8166-732X); Mark Regan (0000-0003-1348-7877); Myles Joyce (0000-0002-9102-8636); Michael Kerin (0000-0003-4164-5561). Author contributions: All authors contributed equally to this paper. All authors had equal input in conception, literature review, drafting, editing and final approval of the paper. Supported by NBCRI, Symptomatic Breast Unit, University Hospital Galway. Conflict-of-interest statement: There is no conflict of interest associated with any of the senior authors or other coauthors contributed their efforts in this manuscript. Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licen ses/by-nc/4.0/ Manuscript source: Invited manuscript Received: May 9, 2019 Gerard Feeney, Rishabh Sehgal, Aisling Hogan, Mark Regan, Myles Joyce, Michael Kerin, Department of General/Colorectal Surgery, Galway University Hospital, Galway H91 YR71, Ireland Margaret Sheehan, Department of Histopathology, Galway University Hospital, Galway H91 YR71, Ireland Corresponding author: Gerard Feeney, MBChB, Doctor, Department of General/Colorectal Surgery, Lambe Institute, Galway University Hospital, Newcastle Road, Galway H91 YR71, Ireland. g.feeney3@outlook.com Telephone: +353-91-524222 Abstract Thirty per cent of all colorectal tumours develop in the rectum. The location of the rectum within the bony pelvis and its proximity to vital structures presents significant therapeutic challenges when considering neoadjuvant options and surgical interventions. Most patients with early rectal cancer can be adequately managed by surgery alone. However, a significant proportion of patients with rectal cancer present with locally advanced disease and will potentially benefit from down staging prior to surgery. Neoadjuvant therapy involves a variety of options including radiotherapy, chemotherapy used alone or in combination. Neoadjuvant radiotherapy in rectal cancer has been shown to be effective in reducing tumour burden in advance of curative surgery. The gold standard surgical rectal cancer management aims to achieve surgical removal of the tumour and all draining lymph nodes, within an intact mesorectal package, in order to minimise local recurrence. It is critically important that all rectal cancer cases are discussed at a multidisciplinary meeting represented by all relevant specialties. Pre-operative staging including CT thorax, abdomen, pelvis to assess for distal disease and magnetic resonance imaging to assess local involvement is essential. Staging radiology and MDT discussion are integral in identifying patients who require neoadjuvant radiotherapy. While Neoadjuvant radiotherapy is potentially beneficial it may also result in morbidity and thus should be reserved for those patients who are at a high risk of local failure, which includes patients with nodal involvement, extramural venous invasion and threatened circumferential margin. The aim of this review is to discuss the role of neoadjuvant radiotherapy in the management of rectal cancer. Key words: Rectal cancer; Neoadjuvant therapy; Low anterior resection syndrome; Stoma; Transanal endoscopic microsurgery; Trans-anal total mesorectal excision; Robotic surgery; Watch and wait WJG https://www.wjgnet.com September 7, 2019 Volume 25 Issue 33 4850