Rectal cancer : Aspects of surgery and radiotherapy

Abstract: In rectal cancer, local failure is one of the principle causes of morbidity and mortality. The use of radiotherapy as an adjuvant treatment in resectable rectal cancer is extensively studied in order to lower unacceptably high local failure rates. Data from the literature clearly indicate that preoperative radiotherapy is superior to postoperative irradiation in reducing failure rates. Provided the dose is sufficiently high, a relative reduction in the local recurrence rate of 60% in combination with "standard" surgery is to be expected. In addition, this reduction seems to increase survival. An important and unanswered question is the role of adjuvant radiotherapy with "optimised" surgery as total mesorectal excision. Our data show that the results of treatment can be improved by concentration of surgery to a colorectal team. Changed primary treatment with a combination of optimised surgery and preoperative radiotherapy will further improve treatment outcome with lowered local recurrence rates and increased survival. With proper radiation technique, the acute-subacute toxicity can be kept acceptably low and besides bowel dysfunction, no evidence of substantial late adverse effects have been found.The cost-effectiveness of preoperative radiotherapy is in accordance with other well-accepted medical interventions.