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World J Gastroenterol. Feb 21, 2011; 17(7): 848-854
Published online Feb 21, 2011. doi: 10.3748/wjg.v17.i7.848
Neoadjuvant vs adjuvant pelvic radiotherapy for locally advanced rectal cancer: Which is superior?
Sarah Popek, Vassiliki Liana Tsikitis
Sarah Popek, Vassiliki Liana Tsikitis, Department of Surgery, University of Arizona, Tucson, AZ 85724, United States
Author contributions: All authors contributed equally to this work; all authors analyzed the data and wrote the paper.
Correspondence to: Vassiliki Liana Tsikitis, MD, Assistant Professor, Department of Surgery, University of Arizona, 1515 N Campbell Ave, Tucson, AZ 85724, United States.
Telephone: +1-520-6266788 Fax: +1-520-6262191
Received: August 30, 2010
Revised: September 29, 2010
Accepted: October 6, 2010
Published online: February 21, 2011

The treatment of locally advanced rectal cancer including timing and dosage of radiotherapy, degree of sphincter preservation with neoadjuvant radiotherapy, and short and long term effects of radiotherapy are controversial topics. The MEDLINE, Cochrane Library databases, and meeting proceedings from the American Society of Clinical Oncology, were searched for reports of randomized controlled trials and meta-analyses comparing neoadjuvant and adjuvant radiotherapy with surgery to surgery alone for rectal cancer. Neoadjuvant radiotherapy shows superior results in terms of local control compared to adjuvant radiotherapy. Neither adjuvant or neoadjuvant radiotherapy impacts overall survival. Short course versus long course neoadjuvant radiotherapy remains controversial. There is insufficient data to conclude that neoadjuvant therapy improves rates of sphincter preserving surgery. Radiation significantly impacts anorectal and sexual function and includes both acute and long term toxicity. Data demonstrate that neoadjuvant radiation causes less toxicity compared to adjuvant radiotherapy, and specifically short course neoadjuvant radiation results in less toxicity than long course neoadjuvant radiation. Neoadjuvant radiotherapy is the preferred modality for administering radiation in locally advanced rectal cancer. There are significant side effects from radiation, including anorectal and sexual dysfunction, which may be less with short course neoadjuvant radiation.

Keywords: Locally advanced rectal cancer, Neoadjuvant radiation, Adjuvant radiation, Rectal neoplasm, Chemoradiotherapy, Neoadjuvant chemoradiotherapy