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An Update on Preoperative Radiotherapy for Locally Advanced Rectal Cancer

대한대장항문학회지 2012년 28권 4호 p.179 ~ 187
 ( Yeo Seung-Gu ) - Soonchunhyang University College of Medicine Department of Radiation Oncology

 ( Kim Dae-Yong ) - National Cancer Center Center for Colorectal Cancer

Abstract


Even in patients undergoing an optimal surgical technique (e.g., total mesorectal excision), radiotherapy provides a significant benefit in the local control of rectal cancer. Compared with postoperative treatment, chemoradiotherapy given preoperatively has been shown to decrease local recurrence rates and toxicity. Additionally, preoperative chemoradiotherapy permits the early identification of tumor responses to this cytotoxic treatment by surgical pathology. Pathological parameters reflecting the tumor response to chemoradiotherapy have been shown to be surrogate markers for long-term clinical outcomes. Post-chemoradiotherapy downstaging from cStage II-III to ypStage 0-I indicates a favorable prognosis, with no difference between ypStage 0 and ypStage I. Research is ongoing to develop useful tools (clinical, molecular, and radiological) for clinical determination of the pathologic chemoradiotherapeutic response before surgery, and possibly even before preoperative treatment. In the future, risk-adapted strategies, including intensification of preoperative therapy, conservative surgery, or the selective administration of postoperative chemotherapy, will be realized for locally-advanced rectal cancer patients based on their response to preoperative chemoradiotherapy.

키워드

Rectal neoplasms; Radiotherapy; Chemoradiotherapy; Neoadjuvant
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