Neoadjuvant treatment intensification or adjuvant chemotherapy for locally advanced XXXX rectum: The optimum treatment approach remains unresolved.

@entity1 @entity137 @entity66 @entity189 @entity348
BACKGROUND: @entity189 [ @entity189 ] is often managed with preoperative radiotherapy or radio-chemotherapy followed by @entity348 ( @entity348 ). Efforts are being made to improve outcome by intensifying the preoperative treatment. However, the optimum therapy remains unclear. There is ongoing controversy regarding the optimum radiation dose, chemotherapy regimen and schedule. In addition there exists growing disagreement regarding the role of adjuvant chemotherapy after neoadjuvant radiation or chemoradiation. METHODOLOGY: We reviewed the recent land mark trials to find a road map in the management of locally advanced @entity189 . RESULTS: Preoperative short course radiotherapy has long been proven to improve @entity66 control. The initial trials with long course chemoradiotherapy, comparing short course radiotherapy have shown to increase local control and pathological complete response rates. Since then treatment intensification of this neoadjuvant schedule has been tried by many researchers. But initial results of these treatment intensification trials, show no significant benefit and are associated with increased @entity137 . There is an unmet need to stratify @entity1 depending on risk to assign them to long course chemoradiotherapy or short course radiotherapy. Current evidence does not support the use of adjuvant chemotherapy in @entity1 who were treated with preoperative (chemo)radiotherapy. CONCLUSION: Preoperative radiotherapy appears to improve disease control with favorable @entity137 profile and there is very little to choose between long course chemoradiotherapy and short course radiotherapy. However, long course chemoradiotherapy may be beneficial for @entity1 with high risk features like positive circumferential resection margin [CRM] and extramural spread of >5mm. There is no role for adjuvant chemotherapy in @entity1 who were treated preoperative (chemo)radiotherapy.
