Abstract
The treatment of rectal cancer has changed considerably in recent years. Progress has been made both in surgery as well as in radio- and chemotherapy. Better knowledge of radial microscopic lymphatic spread within the so-called “mesorectum” has led to the use of total mesorectal excision. With this type of surgery, local control rates have been markedly increased. Technical advances in radiotherapy, and improvements in the sequenzing of radiotherapy, chemotherapy, and surgery have allowed to increase the therapeutic ratio. Moreover, additional agents, e.g., capecitabine, oxaliplatin, or irinotecan as well as targeted therapies, are currently incorporated into multimodality concepts. Moreover, advances both in pathology and imaging have further contributed to the multidisciplinary management. Evidently, the monolithic approaches, established by studies more than a decade ago, to either apply the same schedule of preoperative or postoperative 5-FU-based chemoradiotherapy to all patients with TNM stage II/III rectal cancer or to give preoperative intensive short-course RT according to the Swedish and Dutch concept for all patients with resectable rectal cancer irrespective of tumor stage and location, need to be questioned. The inclusion of different multimodal treatments into the surgical oncological concept, adapted to the tumor location and stage and to individual patient’s risk factors is mandatory. Clearly, future developments will aim at identifying and selecting patients for the ideal treatment alternatives. Thus, clinicopathological and molecular features as well as accurate preoperative imaging and postoperative surgical quality control will take an important and integrative part in multimodality treatment of rectal cancer.
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Rödel, C., Arnold, D., Liersch, T. (2011). Rectal Cancer. In: Blanke, C., Rödel, C., Talamonti, M. (eds) Gastrointestinal Oncology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-13306-0_13
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