Preoperative radiotherapy ± concomitant chemotherapy for rectal cancer

Since 1990, in our Center several phase I or H studies on the use of preoperative chemoradiation have been performed in patients with primary T3-4 rectal cancer or with local recurrence. The aim of this analysis is to report briefly the main results of these trials, in terms of response, sphincter preservation, toxicity and clinical outcome. The first group of studies was performed between 1990 and 1997, with external beam radiotherapy (ERT) and concurrent infusion of 5-Fluorouracil (5-FU) plus bolus injection of Mitomycin C. The second series was carried out between 1995 and 1999 using ERT and concurrent infusion of 5-FU plus injection of cisplatin (c-DDP) or prolonged infusion of 5-FU and ERT concomitant boost. The third series carried out since 1998, involved the use of ERT and the concurrent administration of newer drugs, like raltitrexed and oxaliplatin. The continuous improvement in tumor response after chemoradiation for rectal carcinoma. has led to an increased sphincter-saving rate and, thus, to a better quality of life for the patients. The significant correlation between tumor response and clinical outcome promoted a growing interest in improving the local effect of concurrent preoperative chemoradiation.