Multimodal Treatment of Rectal Cancer

Overview

Journal Dtsch Arztebl Int

Specialties General Medicine
Public Health

Date 2022 Jul 6

PMID 35791271

Authors

Michael Ghadimi

Claus Rodel

Ralf Hofheinz

Hannah Flebbe

Marian Grade

Affiliations

Soon will be listed here.

Abstract

Background: Colorectal cancer is one of the three most common types of cancer in Germany. Approximately 30% of these cancers are located in the rectum, corresponding to about 18 000 new cases per year.

Methods: This review is based on publications retrieved by a selective search in the PubMed database, including current guidelines and recommendations.

Results: Specialized imaging, particularly magnetic resonance imaging, is essential for treatment planning. In very early stages of this disease, tumors without risk factors can be excised locally. Otherwise, radical surgical resection with lymphadenectomy remains the standard treatment, and can be performed either minimally invasive or open. At present, neoadjuvant treatment plans are evolving in the direction of total neoadjuvant therapy. In addition, recent studies investigate whether the improved efficacy of neoadjuvant therapy might now enable patients with a complete clinical remission to be spared from surgical resection (organ-preserving watch-and-wait strategy).

Conclusion: The treatment of rectal cancer is a prime example of an interdisciplinary, multimodal approach. In the past, the focus was mainly on improving oncologic outcomes; at present, increasing attention is being devoted to the patients' quality of life as well and the functional aspects of the various modes of treatment.

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References

Nelson H, Machairas N, Grothey A . Evidence in Favor of Standard Surgical Treatment for Rectal Cancer. JAMA Oncol. 2016; 3(7):885-886. DOI: 10.1001/jamaoncol.2016.5397. View

Carvalho C, Glynne-Jones R . Challenges behind proving efficacy of adjuvant chemotherapy after preoperative chemoradiation for rectal cancer. Lancet Oncol. 2017; 18(6):e354-e363. DOI: 10.1016/S1470-2045(17)30346-7. View

Sauer R, Becker H, Hohenberger W, Rodel C, Wittekind C, Fietkau R . Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004; 351(17):1731-40. DOI: 10.1056/NEJMoa040694. View

Stevenson A, Solomon M, Brown C, Lumley J, Hewett P, Clouston A . Disease-free Survival and Local Recurrence After Laparoscopic-assisted Resection or Open Resection for Rectal Cancer: The Australasian Laparoscopic Cancer of the Rectum Randomized Clinical Trial. Ann Surg. 2018; 269(4):596-602. DOI: 10.1097/SLA.0000000000003021. View

Hofheinz R, Wenz F, Post S, Matzdorff A, Laechelt S, Hartmann J . Chemoradiotherapy with capecitabine versus fluorouracil for locally advanced rectal cancer: a randomised, multicentre, non-inferiority, phase 3 trial. Lancet Oncol. 2012; 13(6):579-88. DOI: 10.1016/S1470-2045(12)70116-X. View

Andersson J, Abis G, Gellerstedt M, Angenete E, Angeras U, Cuesta M . Patient-reported genitourinary dysfunction after laparoscopic and open rectal cancer surgery in a randomized trial (COLOR II). Br J Surg. 2014; 101(10):1272-9. PMC: 4282093. DOI: 10.1002/bjs.9550. View

Ryan J, Warrier S, Lynch A, Ramsay R, Phillips W, Heriot A . Predicting pathological complete response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer: a systematic review. Colorectal Dis. 2015; 18(3):234-46. DOI: 10.1111/codi.13207. View

Lauscher J, Schineis C, Weixler B, Kreis M . [The importance of radiotherapy in rectal cancer-an update from a surgeon's perspective]. Chirurg. 2021; 92(7):591-598. DOI: 10.1007/s00104-021-01414-9. View

Kang S, Park J, Jeong S, Nam B, Choi H, Kim D . Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol. 2010; 11(7):637-45. DOI: 10.1016/S1470-2045(10)70131-5. View

10.

Taylor F, Quirke P, Heald R, Moran B, Blomqvist L, Swift I . Preoperative high-resolution magnetic resonance imaging can identify good prognosis stage I, II, and III rectal cancer best managed by surgery alone: a prospective, multicenter, European study. Ann Surg. 2011; 253(4):711-9. DOI: 10.1097/SLA.0b013e31820b8d52. View

11.

Hunter C, Brown G . Pre-operative staging of rectal cancer: a review of imaging techniques. Expert Rev Gastroenterol Hepatol. 2016; 10(9):1011-25. DOI: 10.1080/17474124.2016.1179577. View

12.

Attenberger U, Rodel C, Ghadimi M, Piso P, Arnold D, Folprecht G . [Prerequisites of magnetic resonance imaging for treatment planning in locally advanced rectal cancer - Interdisciplinary recommendations]. Z Gastroenterol. 2020; 58(6):577-582. DOI: 10.1055/a-1085-6874. View

13.

Fleshman J, Branda M, Sargent D, Boller A, George V, Abbas M . Disease-free Survival and Local Recurrence for Laparoscopic Resection Compared With Open Resection of Stage II to III Rectal Cancer: Follow-up Results of the ACOSOG Z6051 Randomized Controlled Trial. Ann Surg. 2018; 269(4):589-595. PMC: 6360134. DOI: 10.1097/SLA.0000000000003002. View

14.

Keller D, Berho M, Perez R, Wexner S, Chand M . The multidisciplinary management of rectal cancer. Nat Rev Gastroenterol Hepatol. 2020; 17(7):414-429. DOI: 10.1038/s41575-020-0275-y. View

15.

Keller D . Staging of Locally Advanced Rectal Cancer Beyond TME. Clin Colon Rectal Surg. 2020; 33(5):258-267. PMC: 7500963. DOI: 10.1055/s-0040-1713743. View

16.

Beets-Tan R, Beets G . Local staging of rectal cancer: a review of imaging. J Magn Reson Imaging. 2011; 33(5):1012-9. DOI: 10.1002/jmri.22475. View

17.

Kreis M, Ruppert R, Ptok H, Strassburg J, Brosi P, Lewin A . Use of Preoperative Magnetic Resonance Imaging to Select Patients with Rectal Cancer for Neoadjuvant Chemoradiation--Interim Analysis of the German OCUM Trial (NCT01325649). J Gastrointest Surg. 2015; 20(1):25-32. DOI: 10.1007/s11605-015-3011-0. View

18.

Siegel R, Miller K, Fuchs H, Jemal A . Cancer statistics, 2022. CA Cancer J Clin. 2022; 72(1):7-33. DOI: 10.3322/caac.21708. View

19.

Martellucci J . Low Anterior Resection Syndrome: A Treatment Algorithm. Dis Colon Rectum. 2015; 59(1):79-82. DOI: 10.1097/DCR.0000000000000495. View

20.

Park J, Kang S, Hao J, Lim S, Choi H, Kim D . Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): 10-year follow-up of an open-label, non-inferiority, randomised controlled trial. Lancet Gastroenterol Hepatol. 2021; 6(7):569-577. DOI: 10.1016/S2468-1253(21)00094-7. View