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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Dec 10, 2015; 6(6): 225-236
Published online Dec 10, 2015. doi: 10.5306/wjco.v6.i6.225
Adjuvant chemotherapy for rectal cancer: Is it needed?
Kristijonas Milinis, Michael Thornton, Amir Montazeri, Paul S Rooney
Kristijonas Milinis, Faculty of Medicine, University of Liverpool, Liverpool L69 3GE, United Kingdom
Michael Thornton, Paul S Rooney, Department of Colorectal Surgery, the Royal Liverpool University Hospital, Liverpool L7 8XP, United Kingdom
Amir Montazeri, Department of Oncology, the Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool CH63 4JY, United Kingdom
Author contributions: Milinis K, Thornton M, Montazeri A and Rooney PS equally contributed to this paper.
Conflict-of-interest statement: Authors have no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Paul S Rooney, MBChB, FRCS, DM, Department of Colorectal Surgery, the Royal Liverpool University Hospital, Prescot Street, Merseyside, Liverpool L7 8XP, United Kingdom. paul.rooney@rlbuht.nhs.uk
Telephone: +44-151-7063426 Fax: +44-151-7063480
Received: April 27, 2015
Peer-review started: April 27, 2015
First decision: June 24, 2015
Revised: August 1, 2015
Accepted: September 7, 2015
Article in press: September 7, 2015
Published online: December 10, 2015
Processing time: 226 Days and 12 Hours
Abstract

Adjuvant chemotherapy has become a standard treatment of advanced rectal cancer in the West. The benefits of adjuvant chemotherapy after surgery alone have been well established. However, controversy surrounds the use adjuvant chemotherapy in patients who received preoperative chemoradiotherapy, despite it being recommended by a number of international guidelines. Results of recent multicentre randomised control trials showed no benefit of adjuvant chemotherapy in terms of survival and rates of distant metastases. However, concerns exist regarding the quality of the studies including inadequate staging modalities, out-dated chemotherapeutic regimens and surgical approaches and small sample sizes. It has become evident that not all the patients respond to adjuvant chemotherapy and more personalised approach should be employed when considering the benefits of adjuvant chemotherapy. The present review discusses the strengths and weaknesses of the current evidence-base and suggests improvements for future studies.

Keywords: Rectal cancer; Adjuvant chemotherapy

Core tip: Adjuvant chemotherapy for rectal cancer is a contentious issue despite its widespread use. Recent randomised controlled trials have shown no benefit in survival of adjuvant chemotherapy in patients treated with preoperative chemoradiotherapy. It is becoming evident that not all patients benefit from adjuvant chemotherapy and identification of these patients should be the focus of future studies. The present review discusses the current evidence-base for adjuvant chemotherapy in rectal cancer and provides directions for future research.