Advances in radiotherapy in operable rectal cancer.
OBJECTIVE
Radiotherapy (RT) reduces local recurrence in rectal cancer but the optimal treatment schedule is unknown. Relevant questions in designing optimal therapy are set out. This review identifies evidence that influences current practice and shapes future trials in treatment of operable rectal cancer.


METHODS
PubMed and MEDLINE search.


RESULTS
RT reduces local recurrence and pre-operative treatment is superior to post-operative treatment. Longer interval to surgery and concurrent chemotherapy are associated with greater downstaging, although influence on sphincter preservation and survival is minimal. Short-course RT (SCRT) demonstrates lower recurrence, but with long-term dysfunction and minimal survival benefit. The role of SCRT should be re-evaluated to encompass new criteria/areas.


CONCLUSIONS
SCRT should be used selectively rather than as a blanket treatment policy. SCRT compounds functional morbidity caused by mesorectal excision which may be excessive in some patient groups, especially early-stage rectal cancer or frail elderly patients. RT and local excision may be a feasible surgical alternative in these groups. Alternatively, SCRT and delayed surgery may be a future alternative to current long-course chemoradiotherapy. As survival is only marginally affected despite low local recurrence, future trials should aim to address metastatic disease. End points which incorporate function and quality of life must be used.
Suppiah
Aravind
A
Academic Surgical Unit, University of Hull and Castle Hill Hospital, Castle Road, Cottingham, UK. aravindsuppiah@hotmail.com
Hartley
John E
JE
Monson
John R T
JR
D005060:Europe; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D012004:Rectal Neoplasms / Q000401:mortality / Q000517:prevention & control* / Q000532:radiotherapy* / Q000601:surgery; D016019:Survival Analysis