Impact of pre‐ and postoperative multimodality therapy on rectal cancer

Abstract

Surgery is the primary treatment of rectal cancer. However, variability in surgical outcomes led to development of combined therapies including pelvic radiation and systemic chemotherapy. The evolution of these therapies both individually and combined, their successes and limitations is discussed in the context of an evolving understanding of rectal cancer biology. The impact of standardized optimal surgery on the need for additional therapy and trends in treating complete responders to neoadjuvant therapy is also reviewed.

p38 Mitogen-activated protein kinase signalling regulates vascular inflammation and epithelial barrier dysfunction in an experimental model of radiation-induced colitis

“…Radiotherapy in combination with surgery not only reduces local recurrence but also improves overall survival in patients with advanced colorectal cancer1, 2. However, it is well known that the toxic effects of radiation restrict the dose given3–5.…”

“…However, it is well known that the toxic effects of radiation restrict the dose given3–5. In particular, radiation‐induced complications in the gastrointestinal tract, including fibrosis and severe diarrhoea, may complicate potentially curative tumour treatment1, 4, 5. Inflammatory changes, such as microvascular injury and epithelial barrier dysfunction, have been implicated as rate‐limiting aspects in the pathophysiology of radiation enteropathy6, 7.…”

The use of morphometric and fractal parameters to assess the effects of 5-fluorouracil, interferon and dexamethasone treatment on colonic anastomosis healing: an experimental study in rats

“…For many years, 5-fluorouracil has been used in adjuvant therapy of colorectal cancer, and it is still considered the gold standard in the post-operative management of this neoplasm [1,8]. The utility of interferons has been also demonstrated for the treatment of colon carcinoma in a number of studies, as agents that can be administered alone or in combination with chemotherapeutics [9,28,29].…”

“…Patients operated upon due to advanced bowel inflammation need a follow-up comprising the administration of systemic steroids [1,2]. Both treatments have been found to have local and systemic adverse effects [3][4][5][6].…”