[Multimodality treatment for colorectal cancer]

Preoperative radiochemotherapy has clear advantages compared to postoperative therapy in rectal carcinoma of UICC stages II and III, and is indicated according to current guidelines. However, it does not reduce the rate of distant metastases. There is therefore a clear need to improve pre- and postoperative systemic treatment, in order to improve survival times. New combination chemotherapy regimens (5-FU/FS + oxaliplatin as well as XELOX) are being tested both pre and postoperatively, in some cases in combination with antibodies (bevacizumab or cetuximab). Instead of conventional neoadjuvant radiotherapy (50.4 Gy over 5-6 weeks), which is combined with neoadjuvant chemotherapy, preoperative short-term radiotherapy (5 x 5 Gy in 5 days) can be used. The advantages and disadvantages must be weighed up on an individual basis until results of the Berlin trial are available.