Concurrent radio-chemotherapy in the adjuvant setting of rectal cancer

Increasing local control remains a major endpoint in the adjuvant setting of rectal cancer. Postoperative concurrent 5FU-based chemotherapy and irradiation demonstrated its value in Duke's B and C patients. Toxicity decreased from the first studies to the current one's in relation with better radiotherapy technique, reduction of chemotherapy duration and quality assurance programs. Because preoperative irradiation alone has demonstrated its value on local control and overall survival, preoperative combined chemoradiotherapy should be investigated. Phase III trials are ongoing comparing preoperative radio-chemotherapy to either preoperative irradiation alone or to postoperative radio-chemotherapy. At this moment, if the patient has been operated, radio-chemotherapy and additional chemotherapy should be offered in the case of Duke's B-C tumor. On the other hand, it should be preferably offered preoperative radiotherapy in case of T3 resectable T4 and hopefully in the context of a controlled clinical trial investigating preoperative concurrent radio-chemotherapy. (authors)