[Role of concomitant chemoradiotherapy in the treatment algorithm for rectal carcinoma]

The article summarizes practical guidelines for the management of rectal cancer. Colorectal cancer alone accounts for about 100,000 death in Europe and 75,000 in the US each year. The current cornerstones of treatment are surgery, radiotherapy (for rectal cancer only) and chemotherapy. At diagnosis the most important factor predicting treatment outcome is the stage of disease. Patients with rectal carcinoma should be classified according to the stage of the disease, including endorectal ultrasound and biopsy of the lesion. Five years after diagnosis, survival reaches about 50%. For early stage disease, surgery remains the standard treatment, but patients with lymph node-negative T3 or T4 lesions or with any lymph node-positive cancer should receive adjuvant radiotherapy and chemotherapy following the surgery. Pelvic radiation therapy decreases local recurrence; the addition of systemic chemotherapy further enhances local control and improves the survival. In patients with T3 or T4 rectal carcinoma the pre-operative therapy (radiation therapy combined with systemic chemotherapy) has potential advantages, including the decreased tumor, less acute toxicity compared with postoperative therapy, increased radio sensitivity due to more oxygenated cells, and enhanced sphincter preservation.