Multidisciplinary treatment of rectal cancer: medical oncology.

The management of rectal cancer requires a multidisciplinary approach with individual treatment based on a careful assessment of tumour location, stage and resectability. Early identification of the patients that are candidates for combined modality treatment is crucial. After showing less acute and long-term toxicity along with an improved local control in a randomized study, pre-operative combined chemoradiation has in fact recently replaced post-operative radiochemotherapy as standard treatment for locally advanced rectal cancer [1]. Multimodality treatment and the optimization of single treatment components [surgery in particular with the introduction of total mesorectal excision (TME)] have concurred to improve the prognosis of locally advanced rectal cancer with local recurrences decreasing from 40 to <10% and overall survival increasing from 50 to 75% in the last 40 years [2]. In addition, low anterior resection (LAR) has progressively replaced abdomino-perineal resection (APR) with rates of sphincter preservation that have moved from <10% in the 1970s to >80% in the 2000s [3]. Of note, the substantial improvement in local control has not been paralleled by a similar decrease in distant metastases that represent the site of failure for up to 30% of patients, despite optimal surgery and preor post-operative radiation with concomitant, radiosensitizing, and sequential, adjuvant, 5fluorouracil (FU)-based chemotherapy (Figure 1) [1, 4, 5]. The role and limits of the chemotherapy regimens used in the standard combined-modality treatment programs for rectal cancer and the ongoing research to improve these regimens will be reviewed in this article in the light of the specific aims and current indications of adjuvant/neoadjuvant treatment. definition of rectal cancer