[Adjuvant and neoadjuvant radiochemotherapy of rectal carcinoma]

Adequate surgical treatment is a prerequisite for any adjuvant and neoadjuvant therapy of rectal cancer. Randomized studies have investigated the role of radiotherapy for more than 20 years. At least two conclusions can be drawn from the data available by now: 1. Radiotherapy combined with 5-FU-chemotherapy is more effective than radiotherapy alone in the adjuvant setting. This prompted a National Cancer Institute Consensus Conference in the USA in 1990 and a German Cancer Society Consensus Conference in 1999 to recommend postoperative combined radiochemotherapy for patients with UICC-stage II and III rectal cancer as standard treatment outside clinical trials. 2. Preoperative radiotherapy is highly effective and can result in marked tumor shrinkage. In T4-tumors primarily not amenable to radical surgery (R0) and in locoregional recurrent disease preoperative radiotherapy in conventional fractionation with concurrent chemotherapy is standard of care in many institutions. Intensive, short-course preoperative radiotherapy according to the swedish concept (5 x 5 Gy) is now used frequently in patients with resectable rectal cancer due to short overall treatment time and early operation. However, major radio- and tumor biological shortcomings have also prompted criticism. Current studies investigate the role of preoperative short-course radiotherapy when surgery is optimized by total mesorectal excision and the role of combined preoperative as compared to postoperative radiochemotherapy for resectable stage II and III rectal cancer.