Current status of radiation therapy for the management of rectal cancer

Neoadjuvant chemoradiation for stage II and III rectal adenocarcinoma patients is delivered on a routine basis. This treatment paradigm, built on decades of clinical study, is continuously evolving. While multiple radiosensitizers have gained a great deal of interest over the past couple of decades, 5-fluorouracil still remains as the standard radiosensitizing agent. Long-course preoperative chemoradiotherapy is the current standard of care in the Unites States, but short-course hypofractionated preoperative radiotherapy is advocated by some investigators. This review will discuss the current standard of care in the preoperative setting for patients with rectal cancer and will also examine the novel ways in which investigators are modifying this regimen in an effort to improve patient outcomes.