Current issues in locally advanced colorectal cancer treated by preoperative chemoradiotherapy

Abstract

In patients with locally advanced rectal cancer, preoperative chemoradiotherapy has proven to significantly improve local control and cause lower treatment-related toxicity compared with postoperative adjuvant treatment. Preoperative chemoradiotherapy followed by total mesorectal excision or tumor specific mesorectal excision has evolved as the standard treatment for locally advanced rectal cancer. The paradigm shift from postoperative to preoperative therapy has raised a series of concerns however that have practical clinical implications. These include the method used to predict patients who will show good response, sphincter preservation, the application of conservative management such as local excision or “wait-and-watch” in patients obtaining a good response following preoperative chemoradiotherapy, and the role of adjuvant chemotherapy. This review addresses these current issues in patients with locally advanced rectal cancer treated by preoperative chemoradiotherapy.

Keywords: Colorectal cancer; Rectal cancer; Preoperative chemoradiotherapy; Conservative; Response

Core tip: In the era of preoperative chemoradiotherapy for rectal cancer, issues such as treatment plan according to response which included application of organ preserving strategies, prediction of response, and role of adjuvant treatment were need to be discussed under circumstances that preoperative chemoradiotherpay spread widely as a standard treatment of rectal cancer.