Role of Radiation Therapy as an Adjuvant Treatment in Rectal Cancer Management

Oh, Jae Hwan; Kim, Dae Yong

Abstract

Surgical resection is a mainstay in the treatment for patients with locally advanced rectal cancer. Despite the introduction of total mesorectal excision, which greatly reduces local recurrence, radiation therapy and chemotherapy have prevailed as integral parts of the modern treatment concept. Phase III studies have shown that postoperative chemoradiotherapy (CRT) improves the local control and overall survival compared with surgery alone in treating patients with stage II, III rectal cancer. Recently, a prospective randomized study with a large sample size and long-term follow-up reported that preoperative CRT resulted in improved local control and sphincter preservation, reduced toxicities, and improved overall survival compared with postoperative CRT. The results of this study provide evidence for the use of preoperative CRT in the treatment of patients with clinical stage II and III rectal cancer. However, accurate pretreatment staging is required to minimize overtreatment and adverse effects.