The standard treatment of locally advanced rectal cancer comprises neoadjuvant chemoradiation followed by total mesorectal excision. This strategy provides low local recurrence rate, however distant recurrence is still an issue and may impact on survival rates. Novel approaches in the neoadjuvant setting have been tested to improve early and late outcomes, as well as to reduce treatment-related toxicity and morbidity. In this review, we discuss the current literature of neoadjuvant treatment in locally advanced rectal cancer, including total neoadjuvant methods, protocols for radiation delivery, chemotherapy regimen and efforts to add novel targeted therapies, selective withdrawal of surgery or radiotherapy, and future perspectives. Moreover, we highlight relevant issues that have emerged with these new treatment possibilities.

局部晚期直肠癌的标准治疗包括新辅助放化疗和全直肠系膜切除术。这种策略提供了较低的局部复发率，但远处复发仍然是一个问题，可能会影响生存率。新辅助治疗中的新方法已经过测试，以改善早期和晚期结果，并减少与治疗相关的毒性和发病率。在这篇综述中，我们讨论了局部晚期直肠癌新辅助治疗的当前文献，包括总体新辅助方法、放射治疗方案、化疗方案和增加新靶向治疗的努力、选择性停止手术或放疗，以及未来的前景。此外，我们强调了这些新的治疗可能性出现的相关问题。