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[Indications for neoadjuvant therapy in rectal carcinoma]
1Klinik und Poliklinik für Strahlentherapie und Radiologische Onkologie, Klinikum rechts der Isar der Technischen Universität München.
Der Chirurg; Zeitschrift Fur Alle Gebiete Der Operativen Medizen
|November 8, 2003
Summary
Preoperative adjuvant treatment is increasingly favored for locally advanced rectal cancer due to better patient tolerance and compliance compared to postoperative options. This approach aims to improve outcomes and potentially preserve continence.
Area of Science:
- Oncology
- Surgical Oncology
- Radiation Oncology
Background:
- Locally advanced, operable rectal carcinoma treatment has evolved with adjuvant therapies.
- Postoperative adjuvant radiochemotherapy remains a standard, yet preoperative options are gaining international favor.
- Patient compliance and tolerance are key considerations in treatment selection.
Purpose of the Study:
- To review the current landscape of adjuvant treatment strategies for rectal cancer.
- To compare preoperative versus postoperative adjuvant treatments for rectal cancer.
- To highlight the benefits and indications for preoperative treatment modalities.
Main Methods:
- Review of interdisciplinary consensus guidelines from the German Cancer Society.
- Analysis of clinical trial data supporting preoperative adjuvant treatment.
- Discussion of specific preoperative radiotherapy and radiochemotherapy regimens.
Main Results:
- Preoperative adjuvant treatment demonstrates comparable or better patient compliance and tolerance.
- Hypofractionated preoperative radiotherapy is an option for resectable T3 tumors.
- Protracted preoperative radiochemotherapy followed by delayed surgery offers additional benefits.
- Preoperative treatment is strongly recommended for T4 tumors with expected non-curative resection (R1/R2).
Conclusions:
- Preoperative adjuvant treatment is increasingly favored for rectal cancer, offering improved tolerance and compliance.
- Specific preoperative regimens, including radiotherapy and radiochemotherapy, are effective for various stages of rectal cancer.
- The goal of R0 resection and multimodal treatment may include the preservation of continence.