Developments in Neoadjuvant Chemotherapy and Radiotherapy in Rectal Cancer

The treatment of rectal cancer has evolved dramatically through the last three decades. Until the 1970’s and 1980’s, surgery was often the only therapeutic modality employed in the treatment of rectal cancer patients. However, local recurrence with surgery alone was significant resulting in patient morbidity and death (Gunderson & Sosin, 1974; Rich et al., 1983). Some studies have demonstrated that adjuvant chemotherapy and radiotherapy (RT) improved local relapse and survival in patients with tumors extending into the perirectal fat (T3) or with involvement of mesorectal or pelvic lymph nodes (N1-3) (Gastrointestinal Tumor Study Group, 1985; National Institutes of Health Consensus Conference, 1990; Wolmark et al, 2000). Neoadjuvant chemoradiotherapy has become the standard of care for stages II and III rectal cancer since the CAO/ARO/AIO trial (Sauer et al, 2004). Ever since, efforts have been made in order to discover which drug or combination of drugs have better results in terms of local recurrence and survival. In this chapter we will give an overview of the history of neoadjuvant chemotherapy and radiotherapy in rectal cancer, the current standards of care as well as ongoing trials in the neoadjuvant setting for locally advanced rectal cancer.