Is radiotherapy for rectal cancer indicated if surgery is optimized?

Patients with rectal cancer may die of their disease, either from systemic recurrence without disease in the pelvis, or from a combination of local and distant metastases. Furthermore, they may die due to complications of more radical surgery or adjuvant therapy. Optimizing surgery and adjuvant RT will not save those destined to die of distant metastases, nor will it prevent all local recurrences. The addition of adjuvant radio(chemo)therapy may reduce the risk of cancer death, but at the increased risk associated with such therapy. Adjuvant treatment is of potential benefit to the minority, whilst potentially damaging to all. There is little evidence to support the use of adjuvant therapy for all, but in carefully selected patients with rectal cancer we believe its use should be targeted to those at highest risk of local recurrence. © 2001 Harcourt Publishers Ltd.