title: Counterpoint: long-course chemoradiation is preferable in the neoadjuvant treatment of rectal cancer.
abstract: There are 2 approaches to preoperative therapy. Short-course (25 Gy in 5 fractions) radiation and long-course (50.4 Gy in 28 fractions) radiation combined with chemotherapy (CMT). Although short-course radiation therapy is used in some European countries, it is not favored in all European countries or North America. Unlike long-course CMT, it cannot be safely combined with adequate doses of systemic concurrent chemotherapy, and, as currently designed, it does not increase sphincter preservation. Long-course CMT remains the preferred regimen for cT3 and/or node-positive disease. With parallel advances in staging, surgery, systemic therapy, and molecular markers, more selective approaches are being investigated.
authors.affiliation: Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, IL 60637, USA. bruce.minsky@uchospitals.edu
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Minsky
mesh_terms: D017024:Chemotherapy, Adjuvant; D019583:Dose Fractionation, Radiation; D019317:Evidence-Based Medicine; D006801:Humans; D008207:Lymphatic Metastasis; D020360:Neoadjuvant Therapy / Q000592:standards*; D009367:Neoplasm Staging; D011300:Preoperative Care / Q000592:standards; D011879:Radiotherapy Dosage; D016032:Randomized Controlled Trials as Topic; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D015996:Survival Rate; D013997:Time Factors