Current debate in the oncologic management of rectal cancer

Abstract

Despite the considerable amount of research in the field, the management of locally advanced rectal cancer remains a subject to debate. To date, effective treatment centers on surgical resection with the standard approach of total mesorectal resection. Radiation therapy and chemotherapy have been incorporated in order to decrease local and systemic recurrence. While it is accepted that a multimodality treatment regimen is indicated, there remains significant debate for how best to accomplish this in regards to order, dosing, and choice of agents. Preoperative radiation is the standard of care, yet remains debated with the option for chemoradiation, short course radiation, and even ongoing studies looking at the possibility of leaving radiation out altogether. Chemotherapy was traditionally incorporated in the adjuvant setting, but recent reports suggest the possibility of improved efficacy and tolerance when given upfront. In this review, the major studies in the management of locally advanced rectal cancer will be discussed. In addition, future directions will be considered such as the role of immunotherapy and ongoing trials looking at timing of chemotherapy, inclusion of radiation, and non-operative management.

Surgical and Survival Outcomes Following Pelvic Exenteration for Locally Advanced Primary Rectal Cancer

“…Neoadjuvant therapy is commonly used to downstage potentially nonresectable tumors into potentially resectable tumors. [27][28] The large majority of patients in the present study received neoadjuvant therapy before pelvic exenteration; however, no overall survival benefit was identified. Interestingly, a difference was seen depending on the subtype of neoadjuvant treatment received and overall survival was longer in those who received radiotherapy alone compared with those who received chemotherapy alone; however, this finding may reflect selection bias.…”

Magnetic resonance imaging for diagnosis and neoadjuvant treatment evaluation in locally advanced rectal cancer: A pictorial review

“…Multimodal treatment of rectal cancer, with the combination of preoperative (neoadjuvant) chemoradiotherapy (CRT) followed by surgery increases local control in locally advanced cancers and has become the standard approach to such rectal cancers[ 1 - 5 ].…”

The role of induction chemotherapy + chemoradiotherapy in localised pancreatic cancer: initial experience in Scotland

“…We predicted from other retrospective series and also from peri-operative regimens in other tumour types-a progression rate of approximately 30% (12,14,15), and for these patients, second line chemotherapy, a clinical trial or best supportive care were considered, as appropriate.…”