Rectal cancer postoperative therapy

Another unique aspect of rectal cancer is the use of neoadjuvant therapy. Preoperative radiation with or without chemotherapy is given to downstage the tumor prior to surgical resection to improve sphincter preservation by making the surgical procedure easier to perform. The issue of preoperative versus postoperative radiation is a subject of debate and investigation in the United States and will require further data to determine the superiority of one method over the other. 

Tepper JE, Cohen AM, Wood WC, et al. Postoperative radiation therapy of rectal cancer. Int J Radiat Oncol Biol Phys 1987 13 5-10. 

Fisher B, Wolmark N, Rockette H, et al. Postoperative adjuvant chemotherapy or radiation therapy for rectal cancer results from NSABP protocol R-01. J Natl Cancer Inst 1988 80 21-29. 

Tepper JE, O Connell MJ, Petroni GR, et al. Adjuvant postoperative fluorouracil-modulated chemotherapy combined with pelvic radiation therapy for rectal cancer initial results of Intergroup 0114. J Clin Oncol 1997 15(5) 2030-2039. 

The Mayo/NCCTG trial compared postoperative XRT alone, postoperative XRT with concurrent fluorouracil plus semustine chemotherapy, and pre- and postirradiation chemotherapy in a similar population of 204 patients with rectal cancer. This was the first randomized trial in which one cycle of combination chemotherapy was given before and after XRT in addition to the administration of fluorouracil during XRT. The use of combined chemotherapy and XRT significantly affected local recurrence, relapse-free survival, and OS as compared to XRT alone. Patients receiving combined therapy experienced an overall relative reduction of recurrence of 34% at... 

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