Adjuvant radiochemotherapy for rectal cancer.

One of the basic questions for radiation oncologists is what we hope to achieve from treatments that are adjuvant to surgery. Can we achieve a better local control? Is there a decrease in metastatic disease? Can we see an effect on overall survival? Although some questions remain to be answered, some general recommendations for the treatment of rectal cancer can be given. Since the NIH recommendations in 1990, the majority of patients with rectal cancer are treated by amultimodality approach. Today surgery with total mesorectal excision (TME) is the standard therapy for cancers of the middle and low rectum in stages T1/2 N0. Radiochemotherapy (adjuvant or neoadjuvant) and short-term preoperative radiotherapy are both feasible approaches for the treatment of stage II and stage III rectal carcinomas. The superiority of any of these concepts is awaited clarifying by randomized trials. Patients with locally advanced rectal cancers (T4) should undergo long-term neoadjuvant radiochemotherapy with consecutive oncological resection.