Preoperative radiotherapy for rectal cancer: implications for surgeons, pathologists and radiologists

Background:  Over 10 000 new cases of rectal cancer are reported in the UK each year and adjuvant treatments, such as preoperative radiotherapy, are now being used almost routinely. Methods:  A literature review was performed on the Medline database for English language publications on preoperative...

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Bibliographic Details
Published in:British journal of surgery 1999-09, Vol.86 (9), p.1108-1120
Main Authors: Wheeler, J. M. D., Warren, B. F., Jones, A. C., Mortensen, N. J. McC
Format: Article
Language:English
Subjects:
Biological and medical sciences
Colorectal Neoplasms - pathology
Colorectal Neoplasms - radiotherapy
Colorectal Neoplasms - surgery
Diseases of the digestive system
Gastroenterology. Liver. Pancreas. Abdomen
Humans
Lymphatic Metastasis
Medical sciences
Neoplasm Staging
Preoperative Care - methods
Radiotherapy Dosage
Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)
Stomach. Duodenum. Small intestine. Colon. Rectum. Anus
Treatment Outcome
Tumors
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Summary:Background:  Over 10 000 new cases of rectal cancer are reported in the UK each year and adjuvant treatments, such as preoperative radiotherapy, are now being used almost routinely. Methods:  A literature review was performed on the Medline database for English language publications on preoperative radiotherapy and rectal cancer. The radioresponsiveness of rectal cancer, tumour downstaging, radiological staging of irradiated rectal cancer, effects of radiotherapy on anastomotic integrity, anorectal and genitourinary function, the role of preoperative radiotherapy in local excision of rectal cancer, and the histological changes peculiar to radiotherapy were evaluated. Results and conclusion:  Following preoperative radiotherapy, rectal cancer may be downstaged or, occasionally, eradicated histologically. Rectal cancer can now be staged accurately before operation, but this is significantly less reliable following irradiation. The pathological specimen must be examined thoroughly before a tumour can be reported to have been eradicated, especially as unique histological changes are produced by radiotherapy. There is no evidence to suggest that preoperative radiotherapy adversely affects anastomotic integrity. It appears that preoperative radiotherapy has some adverse affects on long‐term anorectal dysfunction, but this must not distract from its main objectives in rectal cancer, namely reduced local recurrence rates and improved overall survival. © 1999 British Journal of Surgery Society Ltd
ISSN:0007-1323
1365-2168
DOI:10.1046/j.1365-2168.1999.01209.x