John Libbey Eurotext

Bulletin du Cancer

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Neoadjuvant approach for non-metastatic rectal cancer combining radiotherapy and chemotherapy. Biotargeted drugs Volume 96, issue 3, mars 2009

Authors
Centre Antoine-Lacassagne, 33, avenue Valombrose, 06189 Nice, France, Institut Gustave-Roussy, 39, rue Camille-Desmoulins, 94805 Villejuif, France, Medicine Faculty, 21511 Alexandrie, Égypte, Centre hospitalier universitaire Lyon-Sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France

Neoadjuvant chemoradiotherapy is considered at the present time as the standard treatment of most T3-4 rectal cancer. In France a combination of radiotherapy (45 Gy/5 weeks) with concurrent capecitabine (1 600 mg/m 2) is the most popular protocol. Randomized trials try to optimize this approach using new cytotoxic drugs and/or radiation dose-escalation. The introduction of biotargeted therapies (anti-EGFR or antiangiogenic) is an attractive field especially selecting the treatment according to K-ras mutation. For T2 and ‘early T3’ present studies are using neoadjuvant chemoradiation followed by transanal local excision in case of good tumor response. In frail elderly patients, a new trend is to use mainly exclusive irradiation to control the tumor and avoid the excessive toxicity of open surgery in this group of patients. As rectal cancer is presenting many different clinical situations, an individualised treatment appears justified.