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Clin Colon Rectal Surg
DOI: 10.1055/s-0043-1770709
Review Article

Radiotherapy for Rectal Cancer: How Much is Enough?

William C. Chapman
1   Department of Surgery, Section of Colon Rectal Surgery, Washington University School of Medicine, St. Louis, Missouri
2   Department of Colon and Rectal Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio
,
Steven R. Hunt
1   Department of Surgery, Section of Colon Rectal Surgery, Washington University School of Medicine, St. Louis, Missouri
,
Lauren E. Henke
3   Department of Radiation Oncology, University Hospitals, Cleveland, Ohio
› Author Affiliations
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Abstract

Though resection has been the mainstay of treatment for nonmetastatic rectal cancer over the past century, radiation has become an increasingly integral component of care for locally advanced disease. Today, two predominant radiotherapy approaches—hyperfractionated chemoradiotherapy and “short-course” radiation—are widely utilized to reduce local recurrence and, in some cases, cure disease. Both have been incorporated into total neoadjuvant therapy (TNT) regimens and achieved excellent local control and superior complete response rates compared to chemoradiation alone. Additionally, initial results of “watch and wait” protocols utilizing either radiation modality have been promising. Yet, differences do exist; though short course is cheaper and more convenient for patients, recently published data may show superior complete response and local recurrence rates with chemoradiation. Ultimately, direct comparisons of short-course radiotherapy against chemoradiation within the TNT framework are needed to identify optimal radiation regimens in the treatment of locally advanced rectal cancer.

Keywords

rectal cancer - radiation - radiotherapy - chemoradiation - total neoadjuvant therapy - nonoperative management


Publication History

Article published online:
21 August 2023

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