(Neo-)Adjuvant radiochemotherapy in stage II/III rectal cancer

Summary

Even in the era of improved surgical resection techniques adjuvant or neoadjuvant radio/-chemotherapy contributes to a better local control. Short-course preoperative radiotherapy or long-term preoperative radiochemotherapy are two different options with proven efficacy. The first approach may be reasonable for patients in whom a complete surgical removal is possible upfront. Preoperative combined radiochemotherapy is certainly more appropriate for patients who need significant downsizing of the tumour to achieve a resection with clear surgical margins. Acute toxicity is more pronounced during combined preoperative treatment, but long-term side-effects may be more prevalent when using short-course radiation. So far the increase in local control following neoadjuvant treatment could not be translated in a substantial survival benefit. Improvements in surgical and radiation techniques as well as a more effective systemic treatment may offer further advantages. However the results of ongoing trials employing newer cytotoxic agents together with neoadjuvant radiation have to be awaited before their use can be advocated routinely. RC is a malignant disease that warrants close multidisciplinary cooperation and each discipline should treat the patients with the highest standard of quality to achieve optimal results.