Postoperative chemoradiation for rectal cancer

Abstract

The management of patients with locally advanced rectal cancer (LARC) has evolved with a paradigm shift from postoperative to preoperative, because preoperative chemoradiation (CRT) improves local control and causes less acute and late treatment-related toxicity compared with postoperative. Hence, long-course preoperative CRT is considered a standard strategy in much of Europe and the USA.However, the late effects on anorectal, sexual and urinary function, have prompted an increasing move to omit preoperative treatment in selected cases or early cT3N0 cancers. In addition, small early-staged low rectal cancers are increasingly being treated by local excision/transanal excisional microsurgery (TEM) in organ preservation strategies.Consequently, the definitive surgical histopathology may reveal more advanced stages than predicted clinically, which raises the question whether such patients should be offered postoperative adjuvant pelvic radiation therapy, which also can be associated with complications (which may be more pronounced after radical surgery).