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Do Improvements in Surgical Technique Mean it is Time to be more Selective in our Approach to Neoadjuvant Radiotherapy for Rectal Cancer?

  • Localized Colorectal Cancer (R Glynne-Jones, Section Editor)
  • Published:
Current Colorectal Cancer Reports

Abstract

Surgery is the mainstay of treatment for rectal cancer. Widespread use of total mesorectal excision (TME) has greatly reduced local recurrence, improved survival, and made it possible for most patients to avoid a permanent stoma. Combined modality therapy (CMT) has improved overall results and is now standard treatment for stage II and III rectal cancer. However, CMT has risks: toxicity, delayed chemotherapy, and potential overtreatment. Several investigators report that, for some patients, equivalent recurrence-free and overall survival are possible with TME alone. Many patients can be stratified for treatment according to risk status assessed on the basis of T/N classification, and some may benefit from a more limited approach that excludes pelvic radiation. A multi-institutional prospective, randomized controlled trial is in progress to address this question. As preoperative staging and our understanding of tumor biology continue to improve, we will be better able to assess risk and deliver rectal cancer treatment selectively.

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Conflict of Interest

Martin R. Weiser declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Colorectal Service/Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Room C-1075, New York, NY, 10065, USA

    Martin R. Weiser

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Correspondence to Martin R. Weiser.

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Weiser, M.R. Do Improvements in Surgical Technique Mean it is Time to be more Selective in our Approach to Neoadjuvant Radiotherapy for Rectal Cancer?. Curr Colorectal Cancer Rep 10, 173–179 (2014). https://doi.org/10.1007/s11888-014-0219-4

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  • DOI: https://doi.org/10.1007/s11888-014-0219-4

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