J.Jpn. Surg. Soc.. 118(4): 402-406, 2017

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Feature topic

PREOPERATIVE CHEMORADIOTHERAPY FOR ADVANCED RECTAL CANCER

In advanced rectal cancer treatment, several studies have shown that combinations of surgery, radiotherapy, and chemotherapy markedly reduce the risk of locoregional recurrence, but this has not yet had any major influence on overall survival. The best results were achieved when radiotherapy was administered preoperatively. Preoperative chemoradiotherapy improves locoregional control further when surgery is optimized using total mesorectal excision. Many controversies on the usefulness of chemoradiotherapy still exist, including lateral lymph node metastasis and intersphincteric resection. The paradigm shift toward anorectal preservation in strictly selected patients with clinical complete responses to preoperative chemoradiotherapy is also controversial. Here, we review many of the advances and resultant controversies in preoperative chemoradiotherapy for advanced rectal cancer, and the future directions in the treatment of locally advanced rectal cancer are considered.

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