Adjuvant and neoadjuvant chemoradiation or radiotherapy in rectal cancer—a review focusing on open questions

Lutz Moser1, Jörg-Peter Ritz2, Wolfgang Hinkelbein1 and Stefan Höcht1

(1) Klinik für Radioonkologie und Strahlentherapie, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
(2) Klinik für Allgemein-, Gefäß- und Thoraxchirurgie, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany

Accepted: 21 November 2007 Published online: 7 December 2007

Abstract
Background The therapy of rectal cancer has been a matter of debate since decades, especially with regard to the benefits of neoadjuvant or adjuvant therapies. Principles of additional therapies have been established nearly two decades ago and are questioned nowadays on the basis of more recently modified operative techniques. Benefits and sequelae of therapies have to be balanced against each other, and it seems somewhat likely that a more differentiated strategy than simply stating that every patient with stage II and III rectal cancer needs chemoradiation or radiotherapy will, in long term, be recommended.
Conclusion It should be kept in mind that results of centers of excellence and of phase-III studies with their positively selected patient populations are not representative for all the patients with rectal cancer and physicians treating them.
Keywords Rectal cancer - Radiotherapy - Radiochemotherapy - Sphincter preservation - Local recurrence - Survival - Quality of life