Radiothérapie seule ou associée aux traitements médicaux dans les cancers du rectum

Abstract

Rectal cancer requires a multidisciplinary specialist approach for optimal results. Contact radiotherapy has shown excellent results in T1 N0 disease. A new machine (Papillon 50) should be soon available. Preoperative chemoradiotherapy is the new standard treatment for CT3-CT4 resectable cancer. The local failure rate has dramatically decreased from 30% (20 years ago) down to about 5%. When local failures are disappearing, distant metastases are emerging. The current questions are as follows: 1) How to predict response to chemoradiation to modify the surgical strategy? 2) How to identify patients with high risk of distant metastases to explore more intensive upfront treatments? 3) How to identify the low-risk patient group for which less aggressive treatments may be sufficient?