What Is the Ongoing Recommendation in the Management of Rectal Cancer?

  • V. Valentini
  • Hans-Joachim Schmoll
  • C. J. H. van de Velde


During the past 20 years, we have seen major changes in the way patients with rectal cancer are investigated and treated. The key components are the improvements in preoperative staging, in surgical technique and histopathological assessment of the resected specimen, and in combining multimodality treatments to ameliorate the long-term outcome.



“The authors would like to thank Giuditta Chiloiro (Università Cattolica del Sacro Cuore, Radiation Oncology Department, Rome, Italy) for the excellent support during manuscript editing”


  1. 1.
    Sauer R, Becker H, Hoyhenberger W et al (2004) For the German rectal cancer study group. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740CrossRefPubMedGoogle Scholar
  2. 2.
    Gérard JP, Conroy T, Bonnetain F et al (2006) Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3–4 rectal cancers: results of FFCD 9203. J Clin Oncol 24:4620–4625CrossRefPubMedGoogle Scholar
  3. 3.
    Bosset JF, Collette L, Calais G, Mineur L, Maingon P, Radosevic-Jelic L et al (2006) EORTC Radiotherapy Group Trial 22921. Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 355:1114–1123CrossRefPubMedGoogle Scholar
  4. 4.
    Bujko K, Nowacki MP, Nasierowska-Guttmejer A, Michalski W, Bebenek M, Kryj M (2006) Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer. Br J Surg 93:1215–23.30CrossRefPubMedGoogle Scholar
  5. 5.
    Peeters KC, Marijnen CA, Nagtegaal ID, Kranenbarg EK, Putter H, Wiggers T et al (2007) Dutch colorectal cancer group the TME trial after a median follow-up of six years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg 246:693–701CrossRefPubMedGoogle Scholar
  6. 6.
    Sebag-Montefiore D, Stephens RJ, Steele R, Monson J, Grieve R, Khanna S et al (2009) Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomized trial. Lancet 373:811–820CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Braendengen M, Tveit KM, Berglund A et al (2008) Randomized phase III study comparing preoperative radiotherapy with chemoradiotherapy in nonresectable rectal cancer. J Clin Oncol 26:3687–3694CrossRefPubMedGoogle Scholar
  8. 8.
    Valentini V, Aristei C, Glimelius B et al (2009) multidisciplinary rectal cancer management: second European rectal cancer consensus conference (EURECA-CC2). Radiother Oncol 92(2):148–163CrossRefPubMedGoogle Scholar
  9. 9.
    Schmoll HJ, Van Cutsem E, Stein A, Valentini V, Glimelius B, Haustermans K et al (2012) ESMO Consensus Guidelines for management of patients with colon and rectal cancer. A personalized approach to clinical decision-making. Ann Oncol 23(10):2479–2516CrossRefPubMedGoogle Scholar
  10. 10.
    van de Velde C, Boelens P, Borras J et al (2013) EURECCA colorectal: multidisciplinary management: European consensus conference colon and rectum. Eur J Cancer 49(13):2784–2790CrossRefPubMedGoogle Scholar
  11. 11.
    Roh MS, Colangelo LH, O'Connell MJ et al (2009) Preoperative multimodality therapy improves disease-free survival in patients with carcinoma of the rectum: NSABP R-03. J Clin Oncol 27:5124–5130CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Roh JK, Yothers G (2011) The impact of capecitabine and oxaliplatin in the preoperative multimodality treatment in patients with carcinoma of the rectum: NSABP R-04. J Clin Oncol 29:abstr 3503Google Scholar
  13. 13.
    O’Connell MJ, Martenson JA, Wieand HS et al (1994) Improving adjuvant therapy for rectal cancer by combining protracted-infusion fluorouracil with radiation therapy after curative surgery. N Engl J Med 331:502–507CrossRefPubMedGoogle Scholar
  14. 14.
    Hofheinz RD, Wenz F (2011) Capecitabine (Cape) versus 5-fluorouracil (5-FU)–based (neo)adjuvant chemoradiotherapy (CRT) for locally advanced rectal cancer (LARC): long-term results of a randomized, phase III trial. J Clin Oncol 29:abstr 3504Google Scholar
  15. 15.
    Gerard JP, Azria D, Gourgou-Bourgade S et al (2010) Comparison of two neoadjuvant chemoradiotherapy regimens for locally advanced rectal cancer: results of the phase III trial ACCORD 12/0405-Prodige 2. J Clin Oncol 28:1638–1644CrossRefPubMedGoogle Scholar
  16. 16.
    Bystrom P, Frodin JE, Berglund A, Wilking N, Glimelius B (2004) Phase I study of UFT plus leucovorin with radiotherapy in patients with inextirpable non-rectal gastrointestinal cancer. Radiother Oncol 70:171–175CrossRefPubMedGoogle Scholar
  17. 17.
    Schiebe ME, Reese T, Wenz F et al (2002) Phase I study of oral uracil and Tegafur plus leucovorin and pelvic radiation in patients with recurrent rectal cancer. Anti-Cancer Drugs 13:1005–1009CrossRefPubMedGoogle Scholar
  18. 18.
    Jakobsen A, Appelt AL (2011) The dose-effect relationship in preoperative chemoradiation of locally advanced rectal cancer: preliminary results of a phase III trial. J Clin Oncol 29:abstr 3512Google Scholar
  19. 19.
    Vestermark LW, Jacobsen A, Qvortrup C et al (2008) Long-term results of a phase II trial of high-dose radiotherapy (60 Gy) and UFT/l-leucovorin in patients with non-resectable locally advanced rectal cancer (LARC). Acta Oncol 47:428–433CrossRefPubMedGoogle Scholar
  20. 20.
    Roedel C, Becker H (2011) Preoperative chemoradiotherapy and postoperative chemotherapy with 5-fluorouracil and oxaliplatin versus 5-fluorouracil alone in locally advanced rectal cancer: first results of the German CAO/ARO/AIO-04 randomized phase III trial. J Clin Oncol 29:abstr LBA3505Google Scholar
  21. 21.
    Gray R, Barnwell J, McConkey C, Hills RK, Williams NS, Kerr DJ (2007) Adjuvant chemotherapy versus observation in patients with colorectal cancer: a randomised study. Lancet 370:2020–2029CrossRefPubMedGoogle Scholar
  22. 22.
    Twelves C, Wong A, Nowacki MP et al (2005) Capecitabine as adjuvant treatment for stage III colon cancer. N Engl J Med 352:2696–2704CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2018

Authors and Affiliations

  • V. Valentini
    • 1
  • Hans-Joachim Schmoll
    • 2
  • C. J. H. van de Velde
    • 3
  1. 1.Università Cattolica del Sacro CuoreRadiation Oncology DepartmentRomeItaly
  2. 2.University clinic Halle(Saale)Department for Internal Medicine, Oncology and HematologyHalleGermany
  3. 3.Leiden University Medical CenterDepartment of SurgeryLeidenThe Netherlands

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