Chimioradiothérapie adjuvante des cancers du rectum

Summary sing local control remains a major endpoint in the adjuvant setting of rectal cancer. Postoperative concurrent 5FU-based chemotherapy and irradiation demonstrated its value in Dukeʹs B and C patients. Toxicity decreased from the first studies to the current oneʹs in relation with better radiotherapy technique, reduction of chemotherapy duration and quality assurance programs. Because preoperative irradiation alone has demontrated its value on local control and overall survival, preoperative combined chemoradiotherapy should be investigated. Phase III trials are ongoing comparing preoperative radiochemotherapy to either preoperative irradiation alone or to postoperative radiochemotherapy. At this moment, if the patient has been operated, radiochemotherapy and additional chemotherapy should be offered in the case of Dukeʹs B-C tumor. On the other hand, it should be preferably offered preoperative radiotherapy in case of T3 resectable T4 and hopefully in the context of a controlled clinical trial investigating preoperative concurrent radiochemotherapy.