Pre-operative radiotherapy for rectal carcinoma? Has the case really been made for short course pre-operative radiotherapy if surgical standards for rectal carcinoma are optimal?
Recent publications on early results of the Dutch trial on pre-operative radiotherapy combined with total mesorectal excision (TME) for resectable rectal cancer have initiated a major swing towards routine radiotherapy of this type. However, detailed analysis of the data so far published shows 23.3% microscopic margin involvement and 23.9% macroscopically poor specimens in a sample group. Since only mobile tumours were selected these figures are too high to validate the claim that the whole series represents 'standardized TME surgery'. The role of pre-operative radiotherapy for resectable rectal cancer undergoing optimal surgery therefore remains open. It may be expected that in future the individual indication for pre-operative radiotherapy will be based on the findings of pre-operative modern fine slice high resolution magnetic resonance imaging (MRI).
Hermanek
P
P
Department of Surgery, University Erlangen-Nürnberg, Germany.
Heald
R J
RJ
D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000517:prevention & control*; D011300:Preoperative Care; D012004:Rectal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery