Present indications for adjuvant therapy in resectable rectal cancer

Area of Science:

• Oncology
• Surgical Oncology
• Gastrointestinal Oncology

Background:

• Adjuvant therapy is crucial for resectable rectal cancer to prevent local-regional failure.
• Failure patterns, particularly transmural penetration and lymph node metastasis, dictate treatment indications.
• Controversy exists regarding optimal postoperative adjuvant regimens.

Purpose of the Study:

• To review selection criteria for adjuvant combined modality therapy in rectal cancer.
• To examine the results of adjuvant therapy for clinically resectable rectal cancer.
• To discuss the role of newer chemotherapeutic agents in preoperative treatment.

Main Methods:

• Review of existing literature on adjuvant therapy for rectal cancer.
• Analysis of selection criteria based on pathologic stage and surgical approach.
• Examination of data from Phase I/II trials of novel chemotherapeutic agents.

Main Results:

• Local-regional failure is common in transmural or node-positive rectal cancers despite surgery.
• Treatment failure correlates with transmural extent and lymph node involvement.
• Continuous infusion 5-fluorouracil (5-FU) is preferred if used alone.

Conclusions:

• Combined modality therapy is an effective adjuvant treatment for resectable rectal cancer.
• Adjuvant therapy choices depend on clinical stage, surgical type, and pathologic findings.
• Ongoing trials are evaluating new agents with preoperative radiation therapy.