ABSTRACT
This chapter describes the indications for pre- and postoperative radiation and short course preoperative radiotherapy for rectal cancer, risk factors for local recurrence, the different treatment schedules, the techniques available, the potential complications and how to avoid them, and finally late effects. Many surgeons consider that low rectal cancers will inevitably require an abdominoperineal resection and creation of a permanent stoma, particularly if the sphincter is invaded. In the 1980s, preoperative assessment of tumor resectability was limited to digital rectal examination and assessment of tumor fixity. Some groups have explored alternative more conservative surgical and non-surgical approaches to avoid either an anterior resection in frail or elderly patients or an abdominoperineal excision of the rectum for distal rectal cancer. The radiotherapy plan aims to encompass the mesorectal envelope and all gross sites of disease with a margin. Patients are planned prone with a full bladder to push small bowel superiorly out of the high-dose volume.
