Preoperative Versus Postoperative Treatment for Locally Advanced Rectal Carcinoma

EPIDEMIOLOGY: Overall mortality of rectal cancer at 5 years is approximately 40%. This cancer is commonly diagnosed at an early stage, but because of local relapse and/or metastatic disease, only half of radically resected patients can be considered disease free. COMMON TREATMENT: The value of adding radiotherapy to surgery in the treatment of patients with resectable rectal cancer has been assessed in trials using either preoperative or postoperative irradiation. IMPROVEMENTS IN TREATMENT: Preoperative radiotherapy and complete resection are established modalities for Stage II and III rectal cancer whilst data reporting improvement of survival by preoperative chemoradiotherapy are still not available. At present, the improved results reported by Phase II trials in terms of local control, sphincter saving and tumor regression grade make neoadjuvant treatment the 'standard' therapy only in North America and some other countries, but the concept of preoperative combined modality treatment is not supported globally.