Preoperative radiotherapy for rectal cancer: implications for surgeons, pathologists and radiologists

Background: Over 10 000 new cases of rectal cancer are reported in the UK e ach year and adjuvant treatments, such as preoperative radiotherapy, are no w being used almost routinely. Methods: A literature review was performed on the Medline database for Engl ish language publications on preoperative radiotherapy and rectal cancer. T he radioresponsiveness of rectal cancer, tumour downstaging, radiological s taging of irradiated rectal cancer, effects of radiotherapy on anastomotic integrity, anorectal and genitourinary function, the role of preoperative r adiotherapy in local excision of rectal cancer, and the histological change s peculiar to radiotherapy were evaluated. Results and conclusion: Following preoperative radiotherapy, rectal cancer may be downstaged or, occasionally, eradicated histologically. Rectal cance r can now be staged accurately before operation, but this is significantly less reliable following irradiation. The pathological specimen must be exam ined thoroughly before a tumour can be reported to have been eradicated, es pecially as unique histological changes are produced by radiotherapy. There is no evidence to suggest that preoperative radiotherapy adversely affects anastomotic integrity. It appears that preoperative radiotherapy has some adverse affects on long-term anorectal dysfunction, but this must not distr act from its main objectives in rectal cancer, namely reduced local recurre nce rates and improved overall survival.