Cons of Neoadjuvant Radiotherapy for Non-Fixed Rectal Cancer

ABSTRACT

Neoadujuvant chemoradiation is accepted practice for treatment of fixed (T4) rectal cancer. The use of preoperative radiation (plus or minus chemotherapy) for non-fixed rectal cancer is still somewhat controversial. Although the use of preoperative radiation in the setting of non-fixed rectal cancer is becoming more prevalent, the selective use of postoperative chemoradiation based on pathologic stage is still in common practice. Secondary to the imperfect accuracy of preoperative staging, the morbidity associated with overtreatment is still a significant concern when using neoadjuvant radiotherapy. With the current surgical standard of radical extirpation with total mesorectal excision, the addition of preoperative (or postoperative) radiation is not justified in patients with Stage I, early Stage II (superfical T3N0), or Stage IV disease. When preoperative radiation is used, access to state-of-the-art imaging studies and the use of an experienced ultrasonographer are critical to minimize over- and understaging. When these are not readily available or the clinical stage of an apparent locally-advanced tumor is equivocal, a strong argument can be made for the selective use of postoperative chemoradiation.

KEYWORDS

Neoadjuvant radiation - non-fixed - rectal cancer - overtreatment - cons

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