title: Current treatment of rectal cancer adapted to the individual patient.
abstract: Preoperative radiochemotherapy and total mesorectal excision surgery is a recommended standard therapy for patients with locally advanced rectal cancer. However, some subgroups of patients benefit more than others from this approach. In order to avoid long-term complications of radiation and chemotherapy, efforts are being made to subdivide T3N0 stage using advanced imaging techniques, and to analyze prognostic factors that help to define subgroup risk patients. Long-course radiochemotherapy has the potential of downsizing the tumor before surgery and may increase the chance of sphincter preservation in some patients. Short-course radiotherapy (SCRT), on the other hand, is a practical schedule that better suits patients with intermediated risk tumors, located far from the anal margin. SCRT is also increasingly being used among patients with disseminated disease, before resection of the rectal tumor. Improvements in radiation technique, such as keeping the irradiation target below S2/S3 junction, and the use of IMRT, can reduce the toxicity associated with radiation, specially long-term small bowel toxicity.
authors.affiliation: Department of Radiation Oncology, Hospital Universitario de la Princesa, Madrid, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Cerezo
authors.affiliation: Department of Radiation Oncology, Instituto de Oncohematología, Hospital Universitario Donostia, Donostia, Spain.
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Ciria
authors.affiliation: Departmet of Radiation Oncology, Clínica Universidad de Navarra, Spain.
authors.forename: Leire
authors.initials: L
authors.lastname: Arbea
authors.affiliation: Department of Radiation Oncology, Hospital Universitario de la Princesa, Madrid, Spain.
authors.forename: Olga
authors.initials: O
authors.lastname: Liñán
authors.affiliation: Department of Radiation Oncology, Instituto de Oncohematología, Hospital Universitario Donostia, Donostia, Spain.
authors.forename: Sergio
authors.initials: S
authors.lastname: Cafiero
authors.affiliation: Department of Radiotherapy, Università Cattolica del Sacro Cuore, Policlinico A.Gemelli, Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Valentini
authors.affiliation: Department of Radiation Oncology, Università Campus Bio-Medico, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cellini
keywords: Individualized treatment; Preoperative radiotherapy; Rectal cancer