Current treatment of rectal cancer adapted to the individual patient

Abstract

Preoperative radiochemotherapy and total mesorectal excision surgery is a recommended standard therapy for patients with locally advanced rectal cancer. However, some subgroups of patients benefit more than others from this approach. In order to avoid long-term complications of radiation and chemotherapy, efforts are being made to subdivide T3N0 stage using advanced imaging techniques, and to analyze prognostic factors that help to define subgroup risk patients. Long-course radiochemotherapy has the potential of downsizing the tumor before surgery and may increase the chance of sphincter preservation in some patients. Short-course radiotherapy (SCRT), on the other hand, is a practical schedule that better suits patients with intermediated risk tumors, located far from the anal margin. SCRT is also increasingly being used among patients with disseminated disease, before resection of the rectal tumor. Improvements in radiation technique, such as keeping the irradiation target below S2/S3 junction, and the use of IMRT, can reduce the toxicity associated with radiation, specially long-term small bowel toxicity.

Radiotherapy for Patients With Resected Tumor Deposit–Positive Colorectal Cancer: A Surveillance, Epidemiology, and End Results–Based Population Study

“…11,16,17 Previously, the 6-year and extended 12-year Dutch Total Mesorectal Excision trials found little evidence that RT lowered recurrence risk among rectal cancer patients, but the risk estimates were not stratified by TD status. 18,19 To our knowledge, the prognostic significance of RT in both N0 and N1c CRCs has been studied in small studies and mostly among rectal cancer cases. 9,16,20,21 One study examined the effect of RT among 628 Korean patients with rectal cancer who underwent curative resection, showing that there was no significant difference in DFS or overall survival (OS) by TD status.…”

The importance of a multidisciplinary team in rectal cancer management

“…Even if in this study we haven’t identified statistically significant differences between OS and RFS related to the exact moment of initiation of the adjuvant treatment, international studies have demonstrated that it is very important to administer the adjuvant treatment as soon as possible, according to local resources [ 26 – 28 ]. That is why, in order to analyze all the resources that can be offered to each patient, close collaboration of a multidisciplinary team specialized in rectal cancer is of major importance.…”

Adenomas – Genetic factors in colorectal cancer prevention

“…This limits the use of ineffective treatment and improves the optimal choice. [67][68][69][70] MSI tumors showing microsatellite instability constitute about 15% of colorectal cancers. They are fairly homogeneous in terms of pathology and clinical course characterizing, e.g.…”