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Postoperative Chemoradiation for Rectal Cancer

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Modern Management of Cancer of the Rectum

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Abstract

The management of patients with “locally advanced rectal cancer” (LARC) has evolved with a paradigm shift from postoperative to preoperative, because preoperative chemoradiation (CRT) improves local control and causes less acute and late treatment-related toxicity compared with postoperative. Hence, long-course preoperative CRT is considered a standard strategy in much of Europe and the USA.

However, the late effects on anorectal, sexual and urinary function, have prompted an increasing move to omit preoperative treatment in selected cases or early cT3N0 cancers. In addition, small early-staged low rectal cancers are increasingly being treated by local excision/transanal excisional microsurgery (TEM) in organ preservation strategies.

Consequently, the definitive surgical histopathology may reveal more advanced stages than predicted clinically, which raises the question whether such patients should be offered postoperative adjuvant pelvic radiation therapy, which also can be associated with complications (which may be more pronounced after radical surgery).

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Authors and Affiliations

  1. Department of Radiotherapy and Gastrointestinal Oncology, Mount Vernon Cancer Centre, Northwood, Middlesex, HA6 2RN, UK

    David Tan MB, BS, FRCR & Rob Glynne-Jones FRCP, FRCR

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  1. David Tan MB, BS, FRCR
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  2. Rob Glynne-Jones FRCP, FRCR
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Correspondence to Rob Glynne-Jones FRCP, FRCR .

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Editors and Affiliations

  1. Colon and Rectal Surgery, Yale School of Medicine, New Haven, Connecticut, USA

    Walter E. Longo

  2. Colon and Rectal Surgery, Yale School of Medicine, New Haven, Connecticut, USA

    Vikram Reddy

  3. University of Liverpool St Helens Teaching Hospital, St Helens, United Kingdom

    Riccardo A. Audisio

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Tan, D., Glynne-Jones, R. (2015). Postoperative Chemoradiation for Rectal Cancer. In: Longo, W., Reddy, V., Audisio, R. (eds) Modern Management of Cancer of the Rectum. Springer, London. https://doi.org/10.1007/978-1-4471-6609-2_17

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