Publication Name	World Journal of Gastrointestinal Oncology
Manuscript ID	117579
Country	Morocco

Category	Oncology
Manuscript Type	Letter to the Editor
Article Title	Evolving paradigms and future challenges in neoadjuvant therapy for locally advanced rectal cancer
Manuscript Source	Unsolicited Manuscript
All Author List	Nabil Ismaili and Sanaa El Majjaoui
Funding Agency and Grant Number
Corresponding Author	Nabil Ismaili, Associate Professor, Chief Physician, MD, Professor, Department of Medical Oncology, Mohammed VI Faculty of Medicine, Mohammed VI University of Sciences and Health, Anfa City, Boulevard Mohammed Taïeb Naciri, Commune Hay Hassani, 82 403, Casablanca, Morocco. ismailinabil@yahoo.fr, Casablanca 20000, CASABLANCA, Morocco. ismailinabil@yahoo.fr
Key Words	Locally advanced rectal cancer; Total neoadjuvant therapy; Chemoradiotherapy; Organ preservation; Watch-and-wait; Pathological complete response; Distant metastasis; Quality of life; Personalized medicine
Core Tip	The standard of care for locally advanced rectal cancer is rapidly evolving. Total neoadjuvant therapy, which delivers chemotherapy before surgery, has proven superior to traditional chemoradiotherapy in reducing distant metastases and, as demonstrated by long-term PRODIGE 23 data, improving overall survival. This success has enabled organ preservation strategies (watch-and-wait) for patients achieving a complete clinical response, offering a chance to avoid major surgery in carefully selected cases with a defined and manageable regrowth risk profile. Future management will focus on personalizing these approaches using biomarkers, circulating tumor DNA, and immunotherapy to maximize cure rates while preserving quality of life, though several of these tools remain investigational.
Citation	Ismaili N, El Majjaoui S. Evolving paradigms and future challenges in neoadjuvant therapy for locally advanced rectal cancer. World J Gastrointest Oncol 2026; In press

Received	2025-12-11 01:59
Peer-Review Started	2025-12-11 01:59
First Decision by Editorial Office Director	2025-12-31 07:40
Return for Revision	2025-12-31 07:40
Revised	2025-12-31 22:21
Publication Fee Transferred
Second Decision by Editor	2026-01-07 02:36
Second Decision by Editor-in-Chief
Final Decision by Editorial Office Director	2026-01-07 07:20
Articles in Press	2026-01-07 07:20
Edit the Manuscript by Language Editor
Typeset the Manuscript

ISSN	1948-5204 (online)
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