The article provides a comprehensive review of neoadjuvant treatments for colorectal cancer, focusing on their evolving role and recent advancements. Neoadjuvant therapy, which includes short-course radiotherapy (SCRT), long-course chemoradiotherapy (CRT), and total neoadjuvant therapy (TNT), has been established to improve local disease control in rectal cancer patients. However, its role is evolving due to advancements in treatment modalities and refinements in indications. Key findings include: - **Rectal Cancer**: Preoperative radiotherapy and CRT have shown significant benefits in reducing local recurrence rates, but improvements in overall survival have been limited. TNT, which combines full-dose chemotherapy with SCRT or CRT, has emerged as a promising alternative, offering improved pathological complete response (pCR) rates and reduced systemic relapse risks. - **Colon Cancer**: Neoadjuvant therapy has a less-established role, primarily used for high-risk cases. Studies suggest that neoadjuvant chemotherapy can improve pathological response and tumour downstaging, but its impact on overall survival remains uncertain. - **Non-operative Management (NOM)**: NOM, particularly after clinical complete responses (cCR) to neoadjuvant therapy, is gaining traction as a less invasive approach, offering improved functional outcomes and quality of life compared to surgery. - **Intraperitoneal Chemotherapy (HIPEC)**: HIPEC, used intraoperatively, aims to reduce peritoneal metastases and improve survival rates in colon cancer patients. The review highlights the ongoing challenges in determining the optimal neoadjuvant treatment strategies, emphasizing the need for more robust biomarkers to guide patient selection and treatment choices.The article provides a comprehensive review of neoadjuvant treatments for colorectal cancer, focusing on their evolving role and recent advancements. Neoadjuvant therapy, which includes short-course radiotherapy (SCRT), long-course chemoradiotherapy (CRT), and total neoadjuvant therapy (TNT), has been established to improve local disease control in rectal cancer patients. However, its role is evolving due to advancements in treatment modalities and refinements in indications. Key findings include: - **Rectal Cancer**: Preoperative radiotherapy and CRT have shown significant benefits in reducing local recurrence rates, but improvements in overall survival have been limited. TNT, which combines full-dose chemotherapy with SCRT or CRT, has emerged as a promising alternative, offering improved pathological complete response (pCR) rates and reduced systemic relapse risks. - **Colon Cancer**: Neoadjuvant therapy has a less-established role, primarily used for high-risk cases. Studies suggest that neoadjuvant chemotherapy can improve pathological response and tumour downstaging, but its impact on overall survival remains uncertain. - **Non-operative Management (NOM)**: NOM, particularly after clinical complete responses (cCR) to neoadjuvant therapy, is gaining traction as a less invasive approach, offering improved functional outcomes and quality of life compared to surgery. - **Intraperitoneal Chemotherapy (HIPEC)**: HIPEC, used intraoperatively, aims to reduce peritoneal metastases and improve survival rates in colon cancer patients. The review highlights the ongoing challenges in determining the optimal neoadjuvant treatment strategies, emphasizing the need for more robust biomarkers to guide patient selection and treatment choices.