ABSTRACT
Radiotherapy has been used for several decades in the management of patients with rectal adenocarcinoma, with the aim of decreasing the rate of local relapse and increasing sphincter preservation. Indeed, after surgery alone, 25-35% local failure is generally reported in patients with B2, C1-2 (Astler-Coller) rectal carcinoma.1,2 The efficacy of radiotherapy in reducing the incidence of local relapse has been demonstrated in several randomized trials using total doses between 34.5 Gy and 45 Gy, as preoperative or postoperative treatment.2,3-10 An overview of these randomized trials has been conducted by the Oxford and Institut Gustave Roussy meta-analysis groups, showing a significant (20%) reduction in the rate of locoregional relapse, which was more pronounced for pre-than for postoperative radiotherapy. A small but statistically significant difference in survival (5%) was also observed in favour of the use of radiotherapy compared with no treatment adjuvant to surgery (JP Pignon, personal communication). A direct comparison of preoperative versus postoperative radiotherapy has been performed by a Swedish group, showing that preoperative irradiation was more efficient in reducing local relapse and also was better tolerated.3,11,12
In summary, adjuvant radiotherapy has been shown to be effective in reducing the probability of locoregional relapse in rectal carcinoma, and this may ultimately lead to a survival benefit. Radiotherapy also plays an essential role in the management of fixed (T4) or recurrent rectal carcinomas.
