Traitements adjuvant et néoadjuvant des cancers du rectum

Adjuvant and neoadjuvant treatments of rectal cancer


En cas de cancer du rectum, les objectifs principaux d’un traitement préopératoire sont de diminuer le risque de rechute locale, de permettre une chirurgie conservatrice et, si possible, d’améliorer la survie globale. Un traitement postopératoire peut également être proposé dans certains cas. L’indication et les modalités de ces traitements pré-et postopératoires devront être discutées lors d’une concertation multidisciplinaire et dépendront principalement de la localisation et de l’extension tumorale.


The main objectives of preoperative treatment of rectal cancer are to decrease the risk of local recurrence, allow sphincter-saving procedures, and, if possible, improve overall survival. Adjuvant therapy is also sometimes justified. Indications and modalities of these pre-and postoperative treatments should be discussed in a multidisciplinary fashion; they mainly depend on the tumour’s location and extent of spread.

This is a preview of subscription content, access via your institution.


  1. 1.

    Finn-Faivre C, Maurel J, Benhamiche AM, et al. (1999) Evidence of improving survival of patients with rectal cancer in France: a population-based study. Gut 44: 377–381

    PubMed  CAS  Article  Google Scholar 

  2. 2.

    Camma C, Giunta M, Fiorica F, et al. (2000) Preoperative radiotherapy for resectable rectal cancer: A meta-analysis. JAMA 284: 1008–1015

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Improved survival with preoperative radiotherapy in resectable rectal cancer. Swedish Rectal Cancer Trial. N Engl J Med (1997) 336: 980–987

  4. 4.

    Folkesson J, Birgisson H, Pahlman L, et al. (2005) Swedish Rectal Cancer Trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol 23: 5644–5650

    PubMed  Article  Google Scholar 

  5. 5.

    Kapiteijn E, Marijnen CA, Nagtegaal ID, et al. (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345: 638–646

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Marijnen CA, Peeters KC, Putter H, et al. (2005) Long term results, toxicity and quality of life in the TME trial. In: Gastrointestinal Cancers Symposium 2005, p. Abstract 166

  7. 7.

    Sauer R, Becker H, Hohenberger W, et al. (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351: 1731–1740

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Bosset JF, Pavy JJ, Hamers HP, et al. (1993) Determination of the optimal dose of 5-fluorouracil when combined with low dose D,L-leucovorin and irradiation in rectal cancer: results of three consecutive phase II studies. EORTC Radiotherapy Group. Eur J Cancer 10: 1406–1410

    Article  Google Scholar 

  9. 9.

    Bosset JF, Calais G, Mineur L, et al. (2005) Enhanced tumorocidal effect of chemotherapy with preoperative radiotherapy for rectal cancer: preliminary results — EORTC 22921. J Clin Oncol 23: 5620–5627

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Gerard J, Bonnetain F, Conroy T, et al. (2005) Preoperative (preop) radiotherapy (RT) + 5 FU/folinic acid (FA) in T3–4 rectal cancers: results of the FFCD 9203 randomized trial. Proc Am Soc Clin Oncol 23, No. 16S, Part I of II (June 1 Supplement): 3504

    Google Scholar 

  11. 11.

    Conroy T, Bonnetain F, Chapet O, et al. (2004) Preoperative (preop) radiotherapy (RT) + 5FU/folinic acid (FA) in T3–4 rectal cancers: preliminary results of the FFCD 9203 randomized trial. Proc Am Soc Clin Oncol 22, No 14S (July 15 Supplement): 3626

    Google Scholar 

  12. 12.

    Aschele C, Friso ML, Pucciarelli S, et al. (2005) A phase I–II study of weekly oxaliplatin, 5-fluorouracil continuous infusion and preoperative radiotherapy in locally advanced rectal cancer. Ann Oncol 16: 1140–1146

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Glynne-Jones R, Dunst J, Sebag-Montefiore D (2006) The integration of oral capecitabine into chemoradiation regimens for locally advanced rectal cancer: how successful have we been? Ann Oncol 17: 361–371

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Glynne-Jones R, Sebag-Montefiore D, Maughan TS, et al. (2006) A phase I dose escalation study of continuous oral capecitabine in combination with oxaliplatin and pelvic radiation (XELOX-RT) in patients with locally advanced rectal cancer. Ann Oncol 17: 50–56

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Chau I, Brown G, Cunningham D, et al. (2006) Neoadjuvant capecitabine and oxaliplatin followed by synchronous chemoradiation and total mesorectal excision in magnetic resonance imaging-defined poor-risk rectal cancer. J Clin Oncol 24: 668–674

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Arnaud JP, Nordlinger B, Bosset JF, et al. (1997) Radical surgery and postoperative radiotherapy as combined treatment in rectal cancer. Final results of a phase III study of the European Organization for Research and Treatment of Cancer. Br J Surg 84: 352–357

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Tveit KM, Guldvog I, Hagen S, et al. (1997) Randomized controlled trial of postoperative radiotherapy and short-term time-scheduled 5-fluorouracil against surgery alone in the treatment of Dukes B and C rectal cancer. Norwegian Adjuvant Rectal Cancer Project Group. Br J Surg 84: 1130–1135

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Krook J, Gunderson L (1991) Effective surgical adjuvant therapy for high-risk rectal carcinoma. N Eng J Med 324: 11

    Article  Google Scholar 

  19. 19.

    Gastrointestinal Tumor Study Group (1985) Prolongation of the disease-free interval in surgically treated rectal carcinoma. N Engl J Med 312: 1465–1472

    Article  Google Scholar 

  20. 20.

    Fisher B, Wolmark N, Rockette H, et al. (1988) Postoperative adjuvant chemotherapy or radiation therapy for rectal cancer: results from NSABP protocol R-01. J Natl Cancer Inst 80: 21–29

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    Buyse M, Zeleniuch-Jacquotte A, Chalmers TC (1988) Adjuvant therapy of colorectal cancer. Why we still don’t know. JAMA 259: 3571–3578

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Dube S, Heyen F, Jenicek M (1997) Adjuvant chemotherapy in colorectal carcinoma: results of a meta-analysis. Dis Colon Rectum 40: 35–41

    PubMed  Article  CAS  Google Scholar 

  23. 23.

    Sakamoto J, Hamada C, Kodaira S, et al. (1999) Adjuvant therapy with oral fluoropyrimidines as main chemotherapeutic agents after curative resection for colorectal cancer: individual patient data meta-analysis of randomized trials. Jpn J Clin Oncol 29: 78–86

    PubMed  Article  CAS  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to E. Mitry.

About this article

Cite this article

Mitry, E., Lièvre, A. & Rougier, P. Traitements adjuvant et néoadjuvant des cancers du rectum. Côlon Rectum 1, 13–17 (2007).

Download citation

Mots clés

  • Cancer du rectum
  • Radiothérapie
  • Chimio-thérapie
  • Traitement adjuvant


  • Rectal cancer
  • Radiotherapy
  • Chemotherapy
  • Adjuvant therapy