Surgical adjuvant therapy for rectal cancer: present options

Area of Science:

• Oncology
• Surgical Oncology
• Radiation Oncology

Background:

• Postoperative radiochemotherapy improves survival for Stage II and III rectal cancer.
• Systemic chemotherapy plays a crucial role in rectal cancer treatment protocols.

Purpose of the Study:

• To evaluate the benefits of preoperative chemoradiotherapy for rectal cancer.
• To determine the optimal application of neoadjuvant therapy in rectal cancer management.

Main Methods:

• Combined 5-fluorouracil and leucovorin chemotherapy followed by radiation therapy (30-35 Gy).
• Surgery is performed 4-8 weeks post-treatment, with continued systemic therapy.
• Restaging is conducted before surgical intervention.

Main Results:

• Preoperative irradiation improves resectability of T4 tumors and enables anal preservation for low-lying cancers.
• Neoadjuvant chemoradiotherapy is recommended for T4 and T3 rectal tumors, including those with limited transrectal extension.
• T2 rectal cancers may also benefit from preoperative irradiation.

Conclusions:

• Preoperative chemoradiotherapy is a vital strategy for Stage II and III rectal cancer.
• This approach offers advantages over postoperative treatment, including improved surgical outcomes.
• The protocol should be considered for a broader range of rectal cancer stages and extensions.