Radiotherapy for localized rectal cancer

Abstract

Surgical resection alone was the standard treatment modality for localized rectal cancer until the early 1990s. Total mesorectal excision (TME) has become the actual standard of care for patients with rectal cancer which greatly reduces local recurrences. Despite the introduction of TME, radiotherapy and chemotherapy have prevailed as integral components of modern treatment concepts. The management of localized rectal cancer requires a multi-disciplinary approach with specialist surgeons, gastro-enterologists, and medical and radiation oncologists. The sequence of treatments is more important than ever. Recent studies have highlighted the central role of radiation therapy associated with surgery to optimize local control, especially in stages II and III rectal cancer, and neo-adjuvant radiochemotherapy (RCT) is now considered to be the standard. However, important questions about preoperative diagnosis, fractionation and dosing of shortand long-term radiation therapy, whether shortand long-term radiotherapy are comparable, and which chemotherapeutic drugs should be used in which combination and sequence remain to be answered. This article focuses on the indications of radiotherapy in the setting of rectal cancer, the benefits of concurrent chemoradiation and the integration of novel drugs into the strategy.