Résumé
The gut microbiota is increasingly recognized as a key factor in rectal carcinogenesis. This review synthesizes current clinical and preclinical evidence linking specific microbial signatures, such as Fusobacterium nucleatum, Duodenibacillus massiliensis and colibactin-producing Escherichia coli (CoPEC) to chemoradiotherapy (CRT) treatment efficacy and resistance. Microbiota-driven mechanisms include immune modulation, inflammation, and drug metabolism. We highlight emerging microbial biomarkers and therapeutic strategies such as antibiotics, probiotics, and fecal microbiota transplantation. Integrating microbiome profiling into clinical workflows could refine patient stratification and enhance CRT efficacy in rectal cancer. Ongoing clinical trials aim to validate these associations and establish robust microbial biomarkers for CRT response prediction in rectal cancer.
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•It is well established that the gut microbiota plays a role in colorectal carcinogenesis and in modulating responses to therapy. Nevertheless, few studies have specifically focused on rectal cancer.•Fusobacterium nucleatum and CoPEC are recurrently linked to poor CRC therapeutic outcomes.•The gut microbiota influences CRT efficacy through immune modulation, inflammation, DNA damage, and drug metabolism.•Microbiota-targeted interventions, including antibiotics, probiotics, and FMT, may modulate CRT efficacy and toxicity.•Ongoing clinical trials aim to validate microbial biomarkers and integrate microbiome profiling into treatment stratification.