Recent advances in (chemo-)radiation therapy for rectal cancer: a comprehensive review
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REVIEW
Recent advances in (chemo‑)radiation therapy for rectal cancer: a comprehensive review F. Roeder1* , E. Meldolesi2, S. Gerum1, V. Valentini2† and C. Rödel3†
Abstract The role of radiation therapy in the treatment of (colo)-rectal cancer has changed dramatically over the past decades. Introduced with the aim of reducing the high rates of local recurrences after conventional surgery, major developments in imaging, surgical technique, systemic therapy and radiation delivery have now created a much more complex environment leading to a more personalized approach. Functional aspects including reduction of acute or late treatment-related side effects, sphincter or even organ-preservation and the unsolved problem of still high distant failure rates have become more important while local recurrence rates can be kept low in the vast majority of patients. This review summarizes the actual role of radiation therapy in different subgroups of patients with rectal cancer, including the current standard approach in different subgroups as well as recent developments focusing on neoadjuvant treatment intensification and/or non-operative treatment approaches aiming at organ-preservation. Keywords: Rectal cancer, Chemoradiation, Review Introduction and current standard approach Rectal cancer represents approximately one-third of all colorectal cancer with the second highest incidence and the second highest cause of cancer death in the western society [1]. Considering the restricted role of radiotherapy in the treatment of colon disease, we’ll focus our review mostly on rectal cancer where radiotherapy has a leading position in combination with both surgery and chemotherapy. During the last 3 decades, the role of radiation therapy in the management of locally advanced rectal cancers, has been gradually modified. Starting in the ‘80 s with a prevalent adjuvant role due to its potential in reducing pelvic recurrence after surgical resection and increasing *Correspondence: Falk.Roeder@t‑online.de † V. Valentini and C. Rödel shared senior authorship 1 Department of Radiotherapy and Radiation Oncology, Paracelsus Medical University, Landeskrankenhaus, Müllner Hautpstrasse 48, 5020 Salzburg, Austria Full list of author information is available at the end of the article
survival rates when combined with 5-FU based chemotherapy [2], radiotherapy was challenged, in the early ‘90 s, with the introduction of total mesorectal excision (TME) that significantly decreased locoregional recurrence (LRR) by itself, questioning the necessity of radiotherapy before or after surgery [3]. Several short course (5 Gy × 5 days) randomized trials [4–9] have demonstrated the importance of preoperative RT plus TME in reducing LRR, in stage II and III rectal cancer patients. The assumption that adding chemotherapy to long course (45–50 Gy) preoperative radiotherapy could increase the local effect of radiotherapy, led to the comparison between radiotherapy and radiochemotherapy as neoadjuvant regimen [10]. The addition of concomitant ch
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