Preoperative radiotherapy in rectal cancer

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Abstract
A review is made of the clinical experience of preoperative radiotherapy in patients with operable cancer of the rectum or rectosigmoid. The randomized clinical trials that have been reported are evaluated. It is concluded that preoperative irradiation using a dose of no less than 34.5 gray in 15 daily fractions [Nominal Standard Dose (NSD) 1,290] can reduce locoregional recurrences and improve disease‐free survival. Doses of this order are not associated with any significant increase of morbidity. The administration of lower doses has not been confirmed to be of any benefit.It is suggested that patients with fixed or partially fixed cancers of the rectum or rectosigmoid should be selected for preoperative adjuvant radiotherapy. This group has a low probability of undergoing curative resection without adjuvant treatment. Local recurrence is high and survival poor in this group of patients.Patients with mobile cancer of the rectum should probably proceed to definitive resection and be considered for postoperative radiotherapy (perhaps combined with chemotherapy) if found to have Dukes' stage B or C cancer. This policy also minimizes the probability of irradiating patients with Dukes' A cancer who are unlikely to benefit from such adjuvant treatment.