Role of Radiotherapy With Surgery for T3 and Resectable T4 Rectal Cancer: Evidence From Randomized Trials

Abstract

In 2005 examination of randomized trials provides evidence for the benefit of preoperative chemoradiation in improving local control and probably sphincter preservation in rectal cancer. Randomized trials should be designed to further demonstrate improved sphincter preservation and to increase survival using adjuvant medical treatments.

Advances in Radiotherapy in Operable Rectal Cancer

“…The lower downstaging effect seen after SCRT would mean more patients in this group would receive post-operative CT, which would influence survival data. A similar trial (TROG 44) is underway comparing SCRT with LCCRT [2]. Further trials will be required to establish whether the differences between the two treatment arms in the Polish trial and TROG 44 are due to the RT dose regime (short high-dose fractions or extended low-dose fractions), concurrent CT or the different time interval to surgery.…”

“…The 13 × 3 Gy in this trial treatment differs from 5 × 5 Gy SCRT [2]. There is no evidence of 5 × 5 Gy SCRT with delayed surgery.…”

“…Total mesorectal excision (TME) has led to significant reduction in local recurrences from 40% 20 years ago to less than 15% [1, 2]. Neo-adjuvant and adjuvant therapies are used to further reduce local recurrence.…”

Colonic Reservoirs in Patients After Rectal Resection

“…In patients with tumour regression following preoperative radio-or radio-chemotherapy, we maintain the specimen resection line at the level pre-planned before irradiation. The distal 2 cm margin of the intestinal wall may be smaller if intraoperative microscopic examination rules out malignant infiltration within the resection line (5)(6)(7)(8)(9). In cases of cancer at low location, it is only allowable to resect the rectum along with part of the anus (particularly including the internal anal sphincter, but also with inclusion of the entire internal and part of the external anal sphincter), if this guarantees appropriate quality of the resection margin and preserves the efficiency of the sphincter apparatus to control defecation (10,11,12).…”

“…New methods of oncological treatment and rehabilitation, utilization of increasingly sophisticated staplers for surgical procedures and the achievements of videosurgery, all promise further improvement of the quality of life of patients undergoing rectal resection in which the anus was spared and a fecal reservoir formed (7,11,61,62,63).…”