New aspects of adjuvant radiotherapy in primarily resectable XXXX .

@entity5 @entity1 @entity348 @entity1487
Local recurrence rates of approximately 30% have been consistently reported after 'conventional surgery' in stage II + III @entity5 @entity1 . Postoperative radiotherapy decreases the local recurrence rate only moderately and is not associated with a gain in survival. Preoperative radiotherapy with biologically effective doses > 30 Gy dramatically reduces the relative risk of local recurrences by 57% that translates into significant overall survival benefit. Postoperative @entity1487 -based chemotherapy in combination with radiotherapy has also been shown to increase @entity5 control and to result in a significantly better survival. However, an improved surgical technique, the @entity348 ( @entity348 ), has evolved and is considered standard treatment by many surgeons. With this technique, reduced local recurrence rates of below 10% and improved survival rates have been reported from different institutions. Therefore, a discussion has started, whether or not pre- or postoperative radiotherapy and chemotherapy is beneficial, when @entity348 is used. The preliminary results of a recently published trial on radiotherapy before @entity348 partly resolve the current controversy. An expected local failure rate of approximately 15% and an overall survival rate below 60%, 5 years after @entity348 alone in stage II + III @entity5 @entity1 suggest the need for additional therapy. Preoperative radiotherapy reduced the risk of local recurrence more than 3 times, indicating that the use of radiotherapy is justified at least in @entity1 with @entity5 , even if optimal surgery was used. The unsatisfactory overall survival gives indirect evidence that these @entity1 will also benefit from chemotherapy. However, many questions remain open and an optimal therapeutic schedule has not been established.
