[Prevention of pelvic recurrence by preoperative radiochemotherapy and total mesorectal excision of rectal carcinoma?].
Preoperative radiotherapy (RT) alone or in combination with a pre- or postoperative chemotherapy reduces the recurrence rate and increases the survival rate for patients with resectable rectal cancer. The therapeutic index, i.e. relationship between effects and side effects is objective of studies. Especially toxicities to the small intestine and to the sphincter function are evaluated. Preoperative radiotherapy achieves the best results. The treatment volume includes the mesorectum in case of continence maintaining surgery and includes the anal sphincter in case of abdominoperineal resection. To exclude the small intestine from the RT-field, we prefer the use of 3 or 4 field technique in a prone position with filled bladder, using an optimal field limitation. The Swedish study, which uses 25 Gy in five fractions per week leads to an increased rate of acute and late toxicities. A fractionation schedule using 45-50 Gy in five weeks should be preferred. During the radiotherapy the patient is followed-up once per week. If surgery is foreseen, it should take place as soon as 3 weeks after the end of radiotherapy. If a primary surgery is performed preoperatively, the operative finding should be discussed with the surgeon. Quality control programs have to certify optimal treatment of the patient by radiotherapist and surgeon.
Bosset
J F
JF
Centre Hospitalier Universitaire, Unité de Radiothérapie et Curiethérapie, Hôpital Jean Minjoz, Besançon, France.
Horiot
J C
JC
D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D006801:Humans; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D010386:Pelvic Neoplasms / Q000517:prevention & control / Q000556:secondary*; D018714:Radiotherapy, Adjuvant; D016032:Randomized Controlled Trials as Topic; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*