title: Locally advanced rectal cancer: the importance of a multidisciplinary approach.
abstract: Rectal cancer accounts for a relevant part of colorectal cancer cases, with a mortality of 4-10/100000 per year. The development of locoregional recurrences and the occurrence of distant metastases both influences the prognosis of these patients. In the last two decades, new multimodality strategies have improved the prognosis of locally advanced rectal cancer with a significant reduction of local relapse and an increase in terms of overall survival. Radical surgery still remains the principal curative treatment and the introduction of total mesorectal excision has significantly achieved a reduction in terms of local recurrence rates. The employment of neoadjuvant treatment, delivered before surgery, also achieved an improved local control and an increased sphincter preservation rate in low-lying tumors, with an acceptable acute and late toxicity. This review describes the multidisciplinary management of rectal cancer, focusing on the effectiveness of neoadjuvant chemoradiotherapy and of post-operative adjuvant chemotherapy both in the standard combined modality treatment programs and in the ongoing research to improve these regimens.
authors.affiliation: Rossana Berardi, Elena Maccaroni, Azzurra Onofri, Francesca Morgese, Mariangela Torniai, Michela Tiberi, Consuelo Ferrini, Stefano Cascinu, Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero, Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi di Ancona, 60126 Ancona, Italy.
authors.forename: Rossana
authors.initials: R
authors.lastname: Berardi
authors.affiliation: Rossana Berardi, Elena Maccaroni, Azzurra Onofri, Francesca Morgese, Mariangela Torniai, Michela Tiberi, Consuelo Ferrini, Stefano Cascinu, Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero, Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi di Ancona, 60126 Ancona, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Maccaroni
authors.affiliation: Rossana Berardi, Elena Maccaroni, Azzurra Onofri, Francesca Morgese, Mariangela Torniai, Michela Tiberi, Consuelo Ferrini, Stefano Cascinu, Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero, Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi di Ancona, 60126 Ancona, Italy.
authors.forename: Azzurra
authors.initials: A
authors.lastname: Onofri
authors.affiliation: Rossana Berardi, Elena Maccaroni, Azzurra Onofri, Francesca Morgese, Mariangela Torniai, Michela Tiberi, Consuelo Ferrini, Stefano Cascinu, Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero, Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi di Ancona, 60126 Ancona, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Morgese
authors.affiliation: Rossana Berardi, Elena Maccaroni, Azzurra Onofri, Francesca Morgese, Mariangela Torniai, Michela Tiberi, Consuelo Ferrini, Stefano Cascinu, Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero, Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi di Ancona, 60126 Ancona, Italy.
authors.forename: Mariangela
authors.initials: M
authors.lastname: Torniai
authors.affiliation: Rossana Berardi, Elena Maccaroni, Azzurra Onofri, Francesca Morgese, Mariangela Torniai, Michela Tiberi, Consuelo Ferrini, Stefano Cascinu, Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero, Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi di Ancona, 60126 Ancona, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Tiberi
authors.affiliation: Rossana Berardi, Elena Maccaroni, Azzurra Onofri, Francesca Morgese, Mariangela Torniai, Michela Tiberi, Consuelo Ferrini, Stefano Cascinu, Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero, Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi di Ancona, 60126 Ancona, Italy.
authors.forename: Consuelo
authors.initials: C
authors.lastname: Ferrini
authors.affiliation: Rossana Berardi, Elena Maccaroni, Azzurra Onofri, Francesca Morgese, Mariangela Torniai, Michela Tiberi, Consuelo Ferrini, Stefano Cascinu, Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero, Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi di Ancona, 60126 Ancona, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Cascinu
mesh_terms: D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects / Q000401:mortality / Q000592:standards; D017024:Chemotherapy, Adjuvant; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000592:standards; D018450:Disease Progression; D006801:Humans; D058990:Molecular Targeted Therapy; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000401:mortality / Q000592:standards; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D059039:Standard of Care; D016896:Treatment Outcome
keywords: Adjuvant treatment; Locally advanced rectal cancer; Neo-adjuvant treatment; Radio-chemotherapy; Surgery; Target drugs