Preoperative radio-chemotherapy in rectal cancer - actual treatment concepts

Background: In locally advanced rectal cancer R0-resectability is limited a nd outcome is combined with a relatively high rate of local recurrences. Th is paper focusses on experiences with preoperative (neo-)adjuvant therapy a nd the potential improvement of treatment results. Patients and methods: Different therapy regimen were demonstrated under con sideration of therapeutic induced side effects, treatment response (downsta ging) in relation to resectability, recurrence free and overall survival. Results: The rate of treatment induced toxicity of preoperative radio-(chem o-)therapy in locally advanced rectal cancer is acceptable with regard to t he obtained treatment results. Through the pretreatment it was possible to gain a downstaging by nearly 60%. The frequency of local recurrence is sign ificantly reduced by preoperative radiotherapy, and combined radiochemother apy possibly increases the disease free survival. In what extent the result s of treatment could be improved through hyperthermia and/or consecutive po stoperative chemotherapy, is proved at present. Conclusions: Preoperative radio-(chemo-)therapy should be increasingly intr oduced into the standard treatment regimen of locally advanced rectal cance r and has to be optimised within the scope of further studies.