Radiation therapy in the management of rectal cancer

Substantial advances have been made in the adjuvant management of patients with resectable rectal cancer. Increasing interest in patient quality of li fe has promoted the use of radiation therapy to enhance sphincter-preservin g surgical approaches as an alternative to the standard abdominoperineal re section. Because of the suggestion of enhanced sphincter preservation with preoperative therapy and the potential advantage of decreased acute morbidi ty, randomized trials comparing preoperative and postoperative adjuvant com bined modality therapy are ongoing. Recent progress in adjuvant postoperati ve treatment regimens relates to the integration of systemic therapy to rad iation, and redefining the techniques for both modalities. The incorporatio n of improved radiation planning may reduce treatment-related bower toxicit y. The integration of novel chemotherapeutic agents in the adjuvant therapy of rectal cancer remains an active area of investigation. (C) 2001 Lippinc ott Williams & Wilkins. Inc.