Neoadjuvant treatment of rectal cancer

Rectal cancer due to its frequent local invasion, high recurrence rate and metastatic potential is a serious health problem, leading to decreased life quality, severe complaints and death. Treatment for locally advanced, resectable rectal cancer improved over the years. Various chemotherapy protocols and combinations with radiation therapy and radical surgery – total mesorectal excision (TMA) – are the main elements of current therapy. Preoperative combined chemoradiation followed by surgery is the preferred treatment sequence. Radiation treatment in combination with fluoropyrimidines (infusional 5-fluorouracil [5-FU] or oral capecitabine) is recommended. Clinical trials with oxaliplatin-based neoadjuvant chemoradiation did not improve the pathologic complete response rate (pCR). Oxaliplatin-based treatment was more toxic as compared with 5-FU. The data concerning local recurrence rate and survival are controversial. Adjuvant chemotherapy in some studies improved survival, so – based on positive results in colon cancer – adjuvant FOLFOX chemotherapy may be recommended.