Controversies in Preoperative Chemoradiation for Rectal Cancer

I am pleased to introduce the first issue of E-Updates: Controversies in the Management of Rectal Cancer that will be available to you between now and the end of the year.  The first part will focus on management with preoperative chemoradiation and the second part will explore novel chemoradiation regimens.

When you click on the link below, you will find the first issue “Controversies in Preoperative Chemoradiation for Rectal Cancer”.  In this issue, the role of postoperative chemotherapy is addressed by Dr. Edward Chu, and I address whether novel chemoradiation regimens are more effective. 

In the forthcoming issue, Dr. Philip Paty will address whether local excision is appropriate and Dr. Christopher Willett will examine 3D and IMRT radiation techniques.

I hope that you find these E-Updates timely, interesting, and informative. 

Sincerely yours,

Bruce Minsky, MD
Associate Dean and Professor of Radiation and Cellular Oncology
Pritzker School of Medicine, University of Chicago
Chief Quality Officer
University of Chicago Medical Center
Chicago, Illinois

Introduction
Since the early 1990s, postoperative adjuvant chemoradiotherapy was widely viewed as the main approach to treat patients with stage II and III rectal cancer. Over the past few years, significant efforts have shifted towards developing neoadjuvant approaches, which combine chemotherapy with radiotherapy prior to surgical resection. The pivotal randomized study,  performed in Germany and reported on in 2004, compared preoperative chemoradiotherapy with postoperative adjuvant chemoradiotherapy. Based on that study, neoadjuvant combined modality therapy has now become the standard of care in the United States for patients with locally advanced rectal cancer. The latest developments in neoadjuvant approaches are reviewed in greater detail by Dr. Bruce Minsky. This portion of the E-Update reviews the key clinical trials that focus on the role of chemotherapy in the adjuvant treatment of patients with rectal cancer following surgical resection.