[The adjuvant therapy of rectal carcinoma: its current status]

Adjuvant therapy of rectal cancer has been investigated in randomized trials during the past 20 years. The actual data allow to draw some principle conclusions.

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 exists. Postoperative radiotherapy decreases the risk of local recurrence but has--as postoperative chemotherapy--only marginal impact on survival. Combined adjuvant treatment (radiotherapy plus 5-FU-chemotherapy) has significantly increased the 5-year survival figures by 10 to 15% in 2 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 pre-operative 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 pre-operative strategies.

Postoperative radiochemotherapy (locoregional irradiation with 50 Gy, small volume boost, 6 courses with 5-FU) is recommended as standard adjuvant treatment outside clinical trials for stage II/III patients after curative surgery. Prospective studies should mainly focus on neoadjuvant treatment concepts.