title: On a prolonged interval between rectal cancer (chemo)radiotherapy and surgery.
abstract: Preoperative radiotherapy (RT) or chemoradiotherapy (CRT) is often required before rectal cancer surgery to obtain low local recurrence rates or, in locally advanced tumours, to radically remove the tumour. RT/CRT in tumours responding completely can allow an organ-preserving strategy. The time from the end of the RT/CRT to surgery or to the decision not to operate has been prolonged during recent years. After a brief review of the literature, the relevance of the time interval to surgery is discussed depending upon the indication for RT/CRT. In intermediate rectal cancers, where the aim is to decrease local recurrence rates without any need for down-sizing/-staging, short-course RT with immediate surgery is appropriate. In elderly patients at risk for surgical complications, surgery could be delayed 5-8 weeks. If CRT is used, surgery should be performed when the acute radiation reaction has subsided or after 5-6 weeks. In locally advanced tumours, where CRT is indicated, the optimal delay is 6-8 weeks. In patients not tolerating CRT, short-course RT with a 6-8-week delay is an alternative. If organ preservation is a goal, a first evaluation should preferably be carried out after about 6 weeks, with planned surgery for week 8 if the response is inadequate. In case the response is good, a new evaluation should be carried out after about 12 weeks, with a decision to start a 'watch-and-wait' programme or operate. Chemotherapy in the waiting period is an interesting option, and has been the subject of recent trials with promising results.
authors.affiliation: a Department of Immunology, Genetics and Pathology , Uppsala University , Uppsala , Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Glimelius
mesh_terms: D059248:Chemoradiotherapy / Q000379:methods*; D003131:Combined Modality Therapy; D018450:Disease Progression; D004334:Drug Administration Schedule; D006801:Humans; D009364:Neoplasm Recurrence, Local; D057234:Preoperative Period; D012004:Rectal Neoplasms / Q000601:surgery* / Q000628:therapy*; D013548:Sweden; D013997:Time Factors; D016896:Treatment Outcome
keywords: Chemoradiotherapy; organ preservation; radiation–surgery interval; radiotherapy; rectal cancer