Neoadjuvant radiotherapy in rectal cancer

Abstract

SUMMARY In the treatment of rectal cancer, neoadjuvant (chemo)radiotherapy is used to decrease the locoregional recurrence risk. The most common treatment consists of neoadjuvant radiotherapy to a dose of 45–50 Gy, combined with 5-fluorouracil or capecitabine-based chemotherapy. In parts of Europe, a short-course radiotherapy schedule of 5 × 5 Gy in 1 week is practiced for patients in whom no downstaging is required to achieve a radical resection. With the increased interest in organ preserving strategies, indications for chemoradiotherapy are changing and the focus has changed from achieving radical resections toward maximal downstaging. In this review, indications for and types of neoadjuvant treatment in rectal cancer are discussed, as well as new aspects related to organ preservation.