The treatment for locally advanced rectal cancer involves a multidisciplinary approach in which total mesorectal excision usually is preceeded by (chemo)radiotherapy. Depending on risk factors, adjuvant chemotherapy is frequently applied. Preoperative short course radiotherapy and chemoradiotherapy result in high local control rates. However, the high risk on systemic relapse and the appealing concept of organ preservation urge researchers to explore alternative perioperative strategies. This review provides an overview of the established role of preoperative short course radiotherapy and chemoradiotherapy, as well as the evidence so far for short course radiotherapy with delayed surgery, induction chemotherapy and for neoadjuvant chemotherapy without radiotherapy.

(BELG J MED ONCOL 2020;14(6):254-62)