open access

Vol 18, No 6 (2013)
SpeciaI issue papers
Published online: 2013-11-01
Submitted: 2013-05-07
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Current treatment of rectal cancer adapted to the individual patient

Laura Cerezo, Juan Pablo Ciria, Leire Arbea, Olga Liñán, Sergio Cafiero, Vincenzo Valentini, Francesco Cellini
DOI: 10.1016/j.rpor.2013.08.005
·
Rep Pract Oncol Radiother 2013;18(6):353-362.

open access

Vol 18, No 6 (2013)
SpeciaI issue papers
Published online: 2013-11-01
Submitted: 2013-05-07

Abstract

Preoperative radiochemotherapy and total mesorectal excision surgery is a recommended standard therapy for patients with locally advanced rectal cancer. However, some subgroups of patients benefit more than others from this approach. In order to avoid long-term complications of radiation and chemotherapy, efforts are being made to subdivide T3N0 stage using advanced imaging techniques, and to analyze prognostic factors that help to define subgroup risk patients. Long-course radiochemotherapy has the potential of downsizing the tumor before surgery and may increase the chance of sphincter preservation in some patients. Short-course radiotherapy (SCRT), on the other hand, is a practical schedule that better suits patients with intermediated risk tumors, located far from the anal margin. SCRT is also increasingly being used among patients with disseminated disease, before resection of the rectal tumor. Improvements in radiation technique, such as keeping the irradiation target below S2/S3 junction, and the use of IMRT, can reduce the toxicity associated with radiation, specially long-term small bowel toxicity.

Abstract

Preoperative radiochemotherapy and total mesorectal excision surgery is a recommended standard therapy for patients with locally advanced rectal cancer. However, some subgroups of patients benefit more than others from this approach. In order to avoid long-term complications of radiation and chemotherapy, efforts are being made to subdivide T3N0 stage using advanced imaging techniques, and to analyze prognostic factors that help to define subgroup risk patients. Long-course radiochemotherapy has the potential of downsizing the tumor before surgery and may increase the chance of sphincter preservation in some patients. Short-course radiotherapy (SCRT), on the other hand, is a practical schedule that better suits patients with intermediated risk tumors, located far from the anal margin. SCRT is also increasingly being used among patients with disseminated disease, before resection of the rectal tumor. Improvements in radiation technique, such as keeping the irradiation target below S2/S3 junction, and the use of IMRT, can reduce the toxicity associated with radiation, specially long-term small bowel toxicity.

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Keywords

Rectal cancer; Preoperative radiotherapy; Individualized treatment

About this article
Title

Current treatment of rectal cancer adapted to the individual patient

Journal

Reports of Practical Oncology and Radiotherapy

Issue

Vol 18, No 6 (2013)

Pages

353-362

Published online

2013-11-01

DOI

10.1016/j.rpor.2013.08.005

Bibliographic record

Rep Pract Oncol Radiother 2013;18(6):353-362.

Keywords

Rectal cancer
Preoperative radiotherapy
Individualized treatment

Authors

Laura Cerezo
Juan Pablo Ciria
Leire Arbea
Olga Liñán
Sergio Cafiero
Vincenzo Valentini
Francesco Cellini

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