When Should Preoperative Radiochemotherapy Be Performed?
There are two general approaches to preoperative radiotherapy (RT) in rectal cancer: short-course (25 Gy in five fractions) RT with immediate surgery (i.e., within 10 days of the first fraction of RT) and long-course 5-fluorouracil-based radiochemotherapy (RCTx, 1.8–2.0 Gy per fraction over 5–6 weeks, for a total dose of 45–50.4 Gy) with surgery scheduled approximately 6 weeks thereafter. Both approaches have been shown to improve locoregional tumor control compared with surgery alone . Whereas short-course RT is mainly used in Northern Europe, conventionally fractionated RT with concurrent fluoropyrimidine chemotherapy is the current standard treatment in Southern Europe and the United States. Patients selected for treatment with short-course RT historically include those with cT1-3 disease, whereas those selected for RCTx include cT3-4 and/or cN+ disease. Two randomized trials of short-course RT vs. RCTx have included patients with cT3 and/or cN+ disease.
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