Preoperative and adjuvant treatment of localized rectal cancer

Although postoperative chemoradiation has a proven role in the treatment of stage II to III localized rectal cancer, recent trials have demonstrated the role of preoperative chemoradiation. A recent randomized trial has shown that preoperative chemoradiation yields higher rates of local control and sphincter preservation and lower rates of toxicity, compared with postoperative chemoradiation. Randomized trials have also shown that preoperative chemoradiation yields higher rates of pathologic complete response and local control, compared with radiotherapy alone. In this article, we review recent trials on preoperative and adjuvant therapy of localized rectal cancer. The roles of newer agents, such as capecitabine, oxaliplatin, and bevacizumab, are also discussed, and other key issues in the treatment of localized rectal cancer are reviewed.