SURGICAL ADJUVANT THERAPY FOR RECTAL-CANCER - PRESENT OPTIONS

Recent advances have been made with the publication of the results of GITSG and NCCTG trials, which demonstrated the significant improvement of survival by combined postoperative radiochemotherapy protocols for Stage II and III rectal cancer. These data show that systemic chemoth erapy has a decisive role to play in this policy. Some of the advantag es of preoperative irradiation compared with postoperative radiation t herapy consist of the improvement of resectability of T4 tumors and th e anal preservation for low-lying cancers. These data suggest that pre operative chemoradiotherapy should be applied not only to T4 tumors bu t also to all T3 tumors even when the transrectal extension is limited . The most usual protocol combines 5-fluorouracil (300-350 mg/m(2)/day ) and leucovorin (20 mg/m(2)/day) for 5 days, followed by radiation th erapy (30-35 Gy in 10 fractions within 12-15 days), with surgery takin g place 4 to 8 weeks later, after the tumor has been restaged. Systemi c therapy is continued for four more months. T2 cancers should not be excluded from the benefit of preoperative irradiation.