[Principles of postoperative therapy in rectal carcinoma]

In stage II (T3-4N0) and III (TxN1-2) rectal cancer, adjuvant radiochemotherapy improves overall survival and decreases the rate of local failure compared to only surgical therapy and is regarded as standard for patients with carcinoma of the lower and intermediate rectum. (Preoperative) radiotherapy also decreases the local failure rate following total mesorectal excision. Postoperative radiotherapy has no proven influence on distant metastasis rates or on overall survival. In adjuvant therapy, continuous infusion of 5-flourouracil compared to bolus application increases long-term survival. However, additional administration of leucovorin or levamisole results in increased toxicity and not improved survival. Results of randomized trials of adjuvant therapy with new drugs such as capecitabine, UFT, irinotecan, or oxaliplatin are not yet available. These drugs should not be used outside clinical trials. Elderly patients benefit from adjuvant therapy to the same extent as younger patients and should receive adjuvant radiochemotherapy, if no contraindication exists.