[Adenocarcinoma of the rectum: role of preoperative radiotherapy for the preservation of the sphincter function].
Surgery is the common upfront treatment for patients who present with clinically resectable rectal cancer. Post-operative radiotherapy and/or chemotherapy are usual for resected rectal cancer in the United States, but in some European countries radiotherapy is preferred as preoperative modality. Preoperative radiotherapy, alone or combined with chemotherapy, increases the chances of tumor downstaging and downsizing and it is less toxic than postoperative combined therapy. More than 10 randomized trials of preoperative radiotherapy for resectable cancers have been recently published: eight trials have reported a significant decrease in local recurrence and two trials have found a significant improvement in survival. If the primary end-point of most clinical trials included survival, a further pivotal end-point included presentation of function of the sphincter in the attempt to improve quality of life. Approximately 70-80 percent of patients irradiated preoperatively are now able to undergo sphincter-preserving surgery. Current studies, focused on the interplay between biological properties of rectal cancer and radiation-induced response will clarify the actual role of preoperative radiotherapy and help select patients who may benefit from combined association of chemotherapy with radiotherapy.
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D000230:Adenocarcinoma / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D001003:Anal Canal / Q000502:physiology*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D006801:Humans; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery