Update and hotspot interpretation of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines?): Rectal Cancer (Version 1. 2026): implications for clinical practice in China_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WU Haoying ^1,2 ,  WANG Xiaodong ¹ , YAO Lin ¹ , LI Li ³

1. Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. West China School of Medicine, Sichuan University, Chengdu 610041, P. R. China;
3. Colorectal Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

WANG Xiaodong, Email: wangxiaodong@wchscu.cn

Keywords：

rectal cancer; NCCN guidelines; precision medicine; Chinese clinical practice

DOI：

10.7507/1007-9424.202603123

Video：

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Colorectal cancer is one of the most common malignant tumors of the digestive system, and rectal cancer has attracted extensive attention in clinical diagnosis and treatment. With the advancement of precision medicine, diagnostic and therapeutic strategies for rectal cancer continue to evolve. On March 5, 2026, the National Comprehensive Cancer Network (NCCN) released NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^?): Rectal Cancer (Version 1. 2026). This article systematically summarizes the key updates in this guideline and explores their implications for the clinical practice of rectal cancer in China, aiming to provide more precise and standardized references for the clinical diagnosis and treatment of rectal cancer.

Citation： WU Haoying, WANG Xiaodong, YAO Lin, LI Li. Update and hotspot interpretation of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines?): Rectal Cancer (Version 1. 2026): implications for clinical practice in China. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2026, 33(6): 742-750. doi: 10.7507/1007-9424.202603123 Copy

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5. 中華醫學會外科學分會結直腸外科學組, 中國研究型醫院學會結直腸肛門外科專委會, 中國結直腸臨床研究協作組. 錯配修復功能完整和(或)微衛星穩定型局部進展期直腸癌患者短程放療序貫化療聯合免疫治療的新輔助治療專家共識(2025版). 實用腫瘤雜志, 2025, 40(5): 391-399.
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12. Garmezy B, Gheeya J, Lin HY, et al. Clinical and molecular characterization of POLE mutations as predictive biomarkers of response to immune checkpoint inhibitors in advanced cancers. JCO Precis Oncol, 2022, 6: e2100267. doi: 10.1200/PO.21.00267.
13. Kelly RJ, Bever K, Chao J, et al. Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of gastrointestinal cancer. J Immunother Cancer, 2023, 11(6): e006658. doi: 10.1136/jitc-2022-006658.
14. Subbiah V, Wolf J, Konda B, et al. Tumour-agnostic efficacy and safety of selpercatinib in patients with RET fusion-positive solid tumours other than lung or thyroid tumours (LIBRETTO-001): a phase Ⅰ/Ⅱ, open-label, basket trial. Lancet Oncol, 2022, 23(10): 1261-1273.
15. Drilon A, Laetsch TW, Kummar S, et al. Efficacy of larotrectinib in TRK fusion-positive cancers in adults and children. N Engl J Med, 2018, 378(8): 731-739.
16. Akiyoshi T, Shinozaki E, Maeda Y, et al. ctDNA longitudinal analysis during total neoadjuvant therapy and nonoperative management for locally advanced rectal cancer: a biomarker study from the NOMINATE trial. Clin Cancer Res, 2025, 31(24): 5188-5197.
17. Wang Y, Yang L, Bao H, et al. Utility of ctDNA in predicting response to neoadjuvant chemoradiotherapy and prognosis assessment in locally advanced rectal cancer: a prospective cohort study. PLoS Med, 2021, 18(8): e1003741. doi: 10.1371/journal.pmed.1003741.
18. Hertz DL, Sahai V. Including DPYD on cancer genetic panels to prevent fatal fluoropyrimidine toxicity. J Natl Compr Canc Netw, 2020, 18(4): 372-374.
19. Bahadoer RR, Dijkstra EA, Van Etten B, et al. Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase Ⅲ trial. Lancet Oncol, 2021, 22(1): 29-42.
20. Conroy T, Bosset JF, Etienne PL, et al. Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER-PRODIGE 23): a multicentre, randomised, open-label, phase Ⅲ trial. Lancet Oncol, 2021, 22(5): 702-715.
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23. Gerard JP, Barbet N, Schiappa R, et al. Neoadjuvant chemoradiotherapy with radiation dose escalation with contact X-ray brachytherapy boost or external beam radiotherapy boost for organ preservation in early cT2–cT3 rectal adenocarcinoma (OPERA): a phase Ⅲ, randomised controlled trial. Lancet Gastroenterol Hepatol, 2023, 8(4): 356-367.
24. Garant A, Vasilevsky CA, Boutros M, et al. MORPHEUS phase Ⅱ–Ⅲ study: a pre-planned interim safety analysis and preliminary results. Cancers, 2022, 14(15): 3665. doi: 10.3390/cancers14153665.
25. Cercek A, Lumish M, Sinopoli J, et al. PD-1 blockade in mismatch repair-deficient, locally advanced rectal cancer. N Engl J Med, 2022, 386(25): 2363-2376.
26. Cercek A, Dos Santos Fernandes G, Roxburgh CS, et al. Mismatch repair-deficient rectal cancer and resistance to neoadjuvant chemotherapy. Clin Cancer Res, 2020, 26(13): 3271-3279.
27. Van Der Lei S, Puijk RS, Dijkstra M, et al. Thermal ablation versus surgical resection of small-size colorectal liver metastases (COLLISION): an international, randomised, controlled, phase Ⅲ non-inferiority trial. Lancet Oncol, 2025, 26(2): 187-199.
28. Verheij FS, Omer DM, Williams H, et al. Long-term results of organ preservation in patients with rectal adenocarcinoma treated with total neoadjuvant therapy: the randomized phase Ⅱ OPRA trial. J Clin Oncol, 2024, 42(5): 500-506.
29. Kushi LH, Byers T, Doyle C, et al. American Cancer Society guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin, 2006, 56(5): 254-281.
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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Update and hotspot interpretation of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines?): Rectal Cancer (Version 1. 2026): implications for clinical practice in China

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