[Adjuvant radiochemotherapy of rectal carcinoma]

Adequate surgical treatment is the basis for any adjuvant therapy. However, even in case of optimal surgery local recurrence rates of 20 to 30% are to be expected for stage II/III patients with 5-year-survival figures in the range of 40 to 60%. In some series, e.g. the results of the Surgical Department of the University of Erlangen, a significant correlation between local control and survival does exist. Postoperative radio-therapy decreases the risk of local recurrence but has--as postoperative chemotherapy--only marginal impact on survival. Combined adjuvant treatment (radio-therapy plus 5-FU-chemotherapy) has significantly increased the 5-year survival figures by 10 to 15% in two randomized trials and is considered as standard adjuvant treatment. From a radio-oncological point of view, most studies may be criticized at least in part because of low preoperative doses, inadequate technique without individual treatment planning and shielding, unfavourable fractionation, or dose reductions of radiotherapy in case of chemotherapy. Further improvement of local efficacy of radiotherapy and reduction of therapy-related toxicity seems, therefore, possible. Innovative approaches in radiation oncology mainly include preoperative strategies.