title: EURECCA consensus conference highlights about rectal cancer clinical management: the radiation oncologist's expert review.
abstract: OBJECTIVE
  Although rectal and colon cancer management has progressed greatly in the last few decades clinical outcomes still need to be optimized. Furthermore, consensus is required on several issues as some of the main international guidelines provide different recommendations. The European Registration of Cancer Care (EURECCA) drew up documents to standardize management and care in Europe and aid in decision-making.
  
  
  METHODS
  In the present section the panel of experts reviews and discusses data from the literature on rectal cancer, focusing on recommendations for selecting between short-course radiotherapy (SCRT) and long-course radio-chemotherapy (LCRTCT) as preoperative treatment as well as on the controversies about adjuvant treatment in patients who had received a pre-operative treatment.
  
  
  RESULTS
  The starting-point of the present EURECCA document is that adding SCRT or LCRTCT to TME improved loco-regional control but did not increase overall survival in any single trial which, in any case, had improved with the introduction of total mesorectal excision (TME) into clinical practice. Moderate consensus was achieved for cT3 anyNM0 disease. In this frame, agreement was reached on either SCRT followed by immediate surgery or LCRTCT with delayed surgery for mesorectal fascia (MRF) negative tumors at presentation. LCRTCT was recommended for tumor shrinkage in MRF+ at presentations but if patients were not candidates for chemotherapy, SCRT with delayed surgery is an option/alternative. LCRTCT was recommended for cT4 anycNM0. SCRT offers the advantages of less acute toxicity and lower costs, and LCRTCT tumor shrinkage and down-staging, with 13-36% pathological complete response (pCR) rates. To improve the efficacy of preoperative treatment both SCRT and LCRTCT have been, or are being, associated with diverse schedules of chemotherapy and even new targeted therapies but without any definitive evidence of benefit. Nowadays, standard treatment is fluoropyrimidine alone since alternative agents and regimens have not been shown to be more active, only more toxic.
  
  
  CONCLUSIONS
  The EURECCA panel summarized available evidence in an attempt to reduce variance in rectal cancer management. This is expected to benefit patients. Results from ongoing randomized trials will help clarify some of the issues that are still under debate.
authors.affiliation: Department of Radiation Oncology, Cattedra di Radioterapia, Università Cattolica S. Cuore, Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Valentini
authors.affiliation: Department of Radiology, Oncology and Radiation Science, Uppsala University, Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Glimelius
authors.affiliation: Department of Radiation Oncology, University Hospitals Leuven Campus Gasthuisberg, Belgium.
authors.forename: Karin
authors.initials: K
authors.lastname: Haustermans
authors.affiliation: Department of Clinical Oncology, Leiden University Medical Center, The Netherlands.
authors.forename: Corrie A M
authors.initials: CA
authors.lastname: Marijnen
authors.affiliation: Radiation Oncology, University Hospital of Frankfurt, Germany.
authors.forename: Claus
authors.initials: C
authors.lastname: Rödel
authors.affiliation: Department of Radiation Oncology, Cattedra di Radioterapia, Università Cattolica S. Cuore, Rome, Italy. Electronic address: magambacorta@rm.unicatt.it.
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: Gambacorta
authors.affiliation: Department of Surgery, Leiden University Medical Center, The Netherlands.
authors.forename: Petra G
authors.initials: PG
authors.lastname: Boelens
authors.affiliation: Radiation Oncology Section, Department of Surgery, Radiology and Dentistry, University of Perugia, Italy.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Aristei
authors.affiliation: Department of Surgery, Leiden University Medical Center, The Netherlands.
authors.forename: Cornelis J H
authors.initials: CJ
authors.lastname: van de Velde
mesh_terms: D059248:Chemoradiotherapy; D006801:Humans; D017410:Practice Guidelines as Topic; D018787:Radiation Oncology / Q000379:methods* / Q000592:standards*; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*
keywords: Combined modality therapy; Radiotherapy; Rectal cancer