[Rectal cancer: which initial strategy?]

Surgery is the main treatment of rectal adenocarcinoma. After careful digital examination, rectoscopy and work-up, treatment decision is taken, in agreement with an informed patient according to the tumor stage. Early T1-2 tumors are treated with surgery first. Advanced T3-4 tumors are treated with pre-operative chemo-radiation often using the "CAP 50" regimen. At the present time, almost 60% of patients are definitively cured of their cancer with 75% being able to avoid permanent stoma. Pelvic relapses are seen in less than 6% of cases. In inoperable patients it is possible to cure a high percentage of early T1-2 tumors using external beam RT associated if possible with chemotherapy and 50 kv Contact X-Ray.