Here is another sweeping review to walk us through the evolution from upfront total mesorectal excision ± radiation to modern total neoadjuvant therapy for locally-advanced rectal cancers, highlighting improved complete pathologic response rates and reduced distant metastases. It reminds us that sequencing matters with upfront long-course chemoradiation followed by consolidative chemotherapy consistently yielding higher organ-preservation rate–which, importantly, is not always the ultimate goal depending heavily on tumor location. Meanwhile, compliance with adjuvant chemo remains dismal at <50% in many trials, further supporting the TNT paradigm, or at least ensuring chemotherapy is delivered pre-op when i. It’s worth noting this overall excellent review of equal-parts surgery, chemotherapy, and radiotherapy for rectal cancer has an authorship that is 9-parts surgeon, 2-parts med onc and–you guessed it–0-parts rad onc. | Noiret, J Clin Oncol 2026
