ADJUVANT TREATMENT IN THE CURATIVE MANAGEMENT OF RECTAL-CANCER - A CRITICAL-REVIEW OF THE RESULTS OF CLINICAL RANDOMIZED TRIALS

A critical analysis of the results of randomised studies on adjuvant rectal cancer led to a different interpretation than given by the 1990 National Institutes of Health (NIH) conference which concluded that combined postoperative chemotherapy and radiotherapy resulted in increased local control and survival in stage II and III patients. We think there is not as yet indisputable evidence for the use of such combination postoperatively. Furthermore, this approach resulted in increased toxicity and was only consistent with moderate compliance. Conversely, preoperative radiotherapy, which was not even mentioned in the conclusions and recommendations of the NIH consensus conference, definitely increases local control and should now be proposed as standard initial treatment in T3T4 resectable rectal cancer. Moreover, preoperative concomitant chemotherapy is an attractive area for clinical trials.