Introduction/Background Despite recent advances in the treatment of locally advanced rectal cancer and increasing evidence indicating safe administration of chemotherapy in patients in the second and third trimester of pregnancy, the optimal treatment management of locally advanced rectal cancer in pregnancy is largely unknown because of the rarity of the condition.

Methodology Case report.

Results We present a case of 29-year-old woman with locally advanced rectal cancer (T3N2M0) diagnosed in 15th week of pregnancy. The patient underwent total neoadjuvant treatment (TNT) consisting of eight cycles of FOLFOX chemotherapy during the second and third trimester of pregnancy and concomitant chemoradiotherapy after a Caesarean section. The Caesarean section was performed in 35th week of pregnancy. The child was in physiological condition, with no signs of growth restriction, malformation, or alterations in blood count, and with normal postpartum adaptation. The patient had a favourable response to systemic and local neoadjuvant treatment and finally underwent a radical surgery.

Conclusion A concept of TNT of locally advanced rectal cancer starting with induction FOLFOX chemotherapy allows to postpone the delivery of the foetus to healthy childbirth with a good control of mother rectal cancer including downstaging.

Disclosure Nothing to disclose.