Molecular biomarkers: multiple roles in radiotherapy

Preoperative chemoradiation therapy (CRT) is becoming the standard treatment for patients with locally advanced rectal cancer. However, individual differences in response to treatment range from a complete response to complete resistance. Predicting the tumor response to radiotherapy may improve the efficacy of radiotherapy. This review mainly summarizes recent studies about the molecular biomarkers that can predict the response to radiotherapy in rectal cancer. These studies have indicated that the molecular markers involved in the response to radiotherapy mainly include genes related to radiosensitivity, cancer stem cell-related markers, non-coding RNAs (ncRNAs), single-nucleotide polymorphisms (SNPs) and gene methylation, and other factors including carcinoembryonic antigen (CEA) level, anemia, lymphocytes, and signaling pathways. Many of these identified markers are mainly associated with DNA repair, apoptosis, and cell cycle, but some involve unknown cell mechanisms. We speculate that predictors of radiotherapy response may involve combinations of multiple molecular biomarkers that may be useful for the development of individualized therapy for rectal cancer patients.