J Korean Soc Coloproctol.  2012 Aug;28(4):179-187. 10.3393/jksc.2012.28.4.179.

An Update on Preoperative Radiotherapy for Locally Advanced Rectal Cancer

Affiliations
  • 1Department of Radiation Oncology, Soonchunhyang University College of Medicine, Cheonan, Korea.
  • 2Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea. radiopiakim@hanmail.net

Abstract

Even in patients undergoing an optimal surgical technique (e.g., total mesorectal excision), radiotherapy provides a significant benefit in the local control of rectal cancer. Compared with postoperative treatment, chemoradiotherapy given preoperatively has been shown to decrease local recurrence rates and toxicity. Additionally, preoperative chemoradiotherapy permits the early identification of tumor responses to this cytotoxic treatment by surgical pathology. Pathological parameters reflecting the tumor response to chemoradiotherapy have been shown to be surrogate markers for long-term clinical outcomes. Post-chemoradiotherapy downstaging from cStage II-III to ypStage 0-I indicates a favorable prognosis, with no difference between ypStage 0 and ypStage I. Research is ongoing to develop useful tools (clinical, molecular, and radiological) for clinical determination of the pathologic chemoradiotherapeutic response before surgery, and possibly even before preoperative treatment. In the future, risk-adapted strategies, including intensification of preoperative therapy, conservative surgery, or the selective administration of postoperative chemotherapy, will be realized for locally-advanced rectal cancer patients based on their response to preoperative chemoradiotherapy.

Keyword

Rectal neoplasms; Radiotherapy; Chemoradiotherapy; Neoadjuvant

MeSH Terms

Biomarkers
Chemoradiotherapy
Humans
Pathology, Surgical
Prognosis
Rectal Neoplasms
Recurrence
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