Rectal cancer preoperative therapy

There is currently no definitive role for adjuvant radiation in colon cancer. However, patients who receive surgery for rectal cancer receive radiation therapy to reduce local tumor recurrence. Adjuvant radiation plus chemotherapy is considered standard treatment for patients with stage II or III rectal cancer after the surgical procedure is complete.17 Preoperative radiation may be used to reduce the initial size of rectal cancers in order to make the surgical procedure easier. 

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. 

Hoff PM, Janjan N, Saad Ed, et al. Phase I study of preoperative oral uracil and tegafurplus leucovorin and radiation therapy in rectal cancer. J Clin Oncol 2000 18 3529-3534. 

Radiation Therapy Oncology Group RTOG R-0012 Randomized Phase II Trial of Preoperative Combined Modality Chemoradiation for Distal Rectal Cancer... 

Mitchell EP. Irinotecan in preoperative combined-modality therapy for locally advanced rectal cancer. Oncology (Huntingt) 2000 14(12 Suppl 14) 56-59. 

Minsky BD, Cohen AM, Enker WE, et al. Preoperative 5-FU, low-dose leucovorin, and radiation therapy for locally advanced and unresectable rectal cancer. Ini J Radiat Oncol Biol Phys 1997 37(2) 289-295. 

Rich TA, Skibber JM, Ajani J, et al. Preoperative infusional chemoradiation therapy for stage T3 rectal cancer. Int J Radiat Oncol Biol Phys 1995 32(4) 1025-1029. 

Wagman R, Minsky BD, Cohen AM, et al. Sphincter preservation in rectal cancer with preoperative radiation therapy and coloanal anastomosis long term follow-up. Int JRadiat Oncol Biol Phys 1998 42 51-57. 

Francois Y, Nemoz CJ, Baulieux J, et al. Influence of the interval between preoperative radiation therapy and surgery on downstaging and on the rate of sphincter-sparing surgery for rectal cancer the Lyon R90-01 randomized trial. J Clin Oncol 1999 17(8) 2396-2402. 

Vecchio FM et al. (2005) The relationship of pathologic tumor regression grade (TRG) and outcomes after preoperative therapy in rectal cancer. Int J Radiat Oncol Biol Phys 62(3) 752-760... 

Marsh RD, Chu NM, Vauthey JN, et al. Preoperative treatment of patients with locally advanced unresectable rectal adenocarcinoma utilizing continuous chronobiologically shaped 5-fluorouracil infusion and radiation therapy. Cancer 1996 78(2) 217-225. 

---