Adjuvant chemotherapy for rectal cancer: Is it needed?

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.