Precision Medicine in Rectal Cancer: Contemporary Management and Future Perspectives

The management of rectal cancer is undergoing a profound transformation driven by the integration of precision medicine into multidisciplinary care. While advances in surgical techniques, total neoadjuvant therapy (TNT), organ-preservation strategies, and minimally invasive approaches have substantially improved outcomes, the increasing availability of molecular profiling and next-generation sequencing (NGS) is reshaping therapeutic decision-making across the entire disease continuum.The identification of predictive and prognostic biomarkers—including mismatch repair deficiency (dMMR)/microsatellite instability (MSI), RAS and BRAF mutations, HER2 amplification, NTRK fusions, and other emerging genomic alterations—has expanded opportunities for individualized treatment, particularly in locally advanced and metastatic disease. Furthermore, advances in circulating biomarkers, radiomics, artificial intelligence, and integrated imaging are improving patient selection, treatment response assessment, and long-term surveillance.Despite these remarkable developments, important challenges remain regarding the optimal integration of molecular information into clinical practice, patient stratification, treatment sequencing, organ preservation, and multidisciplinary decision-making. An updated overview of current evidence and future directions is therefore timely and highly relevant.The aim of this Research Topic is to provide a comprehensive overview of how precision medicine is transforming the management of rectal cancer, from diagnosis and treatment selection to response evaluation and survivorship.We welcome contributions from colorectal surgeons, medical oncologists, radiation oncologists, pathologists, radiologists, molecular biologists, geneticists, and translational researchers addressing both established standards and emerging innovations in personalized rectal cancer care.Particular attention will be devoted to molecular profiling and next-generation sequencing (NGS), predictive biomarkers, personalized neoadjuvant and systemic therapies, organ-preservation strategies, minimally invasive and robotic surgery, advanced imaging, artificial intelligence, liquid biopsy, and multidisciplinary approaches integrating genomic and clinical data.By bringing together original research, expert reviews, consensus statements, technical reports, and multidisciplinary perspectives, this Research Topic aims to promote the implementation of precision oncology in rectal cancer, facilitate evidence-based clinical decision-making, and identify future research priorities.This Research Topic welcomes submissions addressing all aspects of precision medicine in rectal cancer, including but not limited to:• Next-generation sequencing (NGS) and molecular profiling• Predictive and prognostic biomarkers (MSI/dMMR, RAS, BRAF, HER2, NTRK, ctDNA, and emerging biomarkers)• Personalized treatment strategies• Precision neoadjuvant therapy and total neoadjuvant therapy (TNT)• Immunotherapy and targeted therapies• Organ-preservation and Watch-and-Wait approaches• Robotic and minimally invasive rectal surgery• Artificial intelligence, radiomics, and digital technologies• Advanced imaging for treatment planning and response assessment• Liquid biopsy and disease monitoring• Functional outcomes and quality of life• Management of locally advanced and recurrent rectal cancer• Multidisciplinary precision oncology pathwaysWe welcome Original Research Articles, Systematic Reviews, Meta-analyses, Narrative Reviews, Clinical Trials, Technical Reports, Expert Opinions, Consensus Statements, and Translational Research. Topic editors: Filippo Carannante, Guglielmo Niccolò Piozzi Source: https://www.frontiersin.org/research-topics/82701/precision-medicine-in-rectal-cancer-contemporary-management-and-future-perspectives