Local therapy for rectal cancer.

Published

Journal Article (Review)

Local procedures for carefully selected distal rectal cancer offer significant advantages such as sphincter preservation and avoidance of radical surgery. However, since preoperative selection criteria including current imaging modalities are unable to definitively stage regional lymph node status, local therapies for rectal cancer have the inherent potential disadvantage of undertreating a fraction of patients due to unresected mesorectal/regional lymph node disease. Current available data suggests that the local approach may be appropriate only for carefully selected T1 tumors with favorable pathologic features. Inferior local control and survival reported for T2 tumors and T1 tumors with unfavorable features, despite the addition of chemoradiation, outweigh the advantages of the local approach. Patients with unfavorable tumors who are unable to tolerate radical resection or who refuse surgery may be treated with local excision with or without adjuvant chemoradiation. Other modalities, such as electrocoagulation and endocavitary radiation, may also be valuable in this setting, as well as preoperative chemoradiation followed by local excision. Regardless of the approach used, all patients undergoing local therapy of a rectal cancer require careful long-term follow-up, because these patients remain at significant risk for local recurrence and distant failure.

Full Text

Duke Authors

Cited Authors

  • Moore, HG; Guillem, JG

Published Date

  • October 2002

Published In

Volume / Issue

  • 82 / 5

Start / End Page

  • 967 - 981

PubMed ID

  • 12507203

Pubmed Central ID

  • 12507203

Electronic International Standard Serial Number (EISSN)

  • 1558-3171

International Standard Serial Number (ISSN)

  • 0039-6109

Digital Object Identifier (DOI)

  • 10.1016/s0039-6109(02)00049-x

Language

  • eng