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World J Gastroenterol. Dec 14, 2014; 20(46): 17279-17287
Published online Dec 14, 2014. doi: 10.3748/wjg.v20.i46.17279
Locally advanced rectal cancer: The importance of a multidisciplinary approach
Rossana Berardi, Elena Maccaroni, Azzurra Onofri, Francesca Morgese, Mariangela Torniai, Michela Tiberi, Consuelo Ferrini, Stefano Cascinu
Rossana Berardi, Elena Maccaroni, Azzurra Onofri, Francesca Morgese, Mariangela Torniai, Michela Tiberi, Consuelo Ferrini, Stefano Cascinu, Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero, Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi di Ancona, 60126 Ancona, Italy
Author contributions: Berardi R and Cascinu S conceived, wrote and edited the manuscript; Maccaroni E extensively reviewed the scientific literature and wrote the manuscript; Onofri A, Morgese F, Torniai M, Tiberi M and Ferrini C were involved in reviewing the literature and in writing and editing the manuscript; all authors have read and approved the manuscript.
Correspondence to: Rossana Berardi, MD, Medical Oncology Unit, Università Politecnica delle Marche, Azienda Ospedaliero, Universitaria, Ospedali Riuniti Umberto I, GM Lancisi, G Salesi di Ancona, via Conca 71, 60126 Ancona, Italy. r.berardi@univpm.it
Telephone: +39-71-5965715 Fax: +39-71-5965053
Received: July 7, 2014
Revised: July 9, 2014
Accepted: July 29, 2014
Published online: December 14, 2014
Abstract

Rectal cancer accounts for a relevant part of colorectal cancer cases, with a mortality of 4-10/100000 per year. The development of locoregional recurrences and the occurrence of distant metastases both influences the prognosis of these patients. In the last two decades, new multimodality strategies have improved the prognosis of locally advanced rectal cancer with a significant reduction of local relapse and an increase in terms of overall survival. Radical surgery still remains the principal curative treatment and the introduction of total mesorectal excision has significantly achieved a reduction in terms of local recurrence rates. The employment of neoadjuvant treatment, delivered before surgery, also achieved an improved local control and an increased sphincter preservation rate in low-lying tumors, with an acceptable acute and late toxicity. This review describes the multidisciplinary management of rectal cancer, focusing on the effectiveness of neoadjuvant chemoradiotherapy and of post-operative adjuvant chemotherapy both in the standard combined modality treatment programs and in the ongoing research to improve these regimens.

Keywords: Locally advanced rectal cancer, Neo-adjuvant treatment, Radio-chemotherapy, Surgery, Adjuvant treatment, Target drugs

Core tip: In the last three decades, multidisciplinary treatments have significantly reduced both local and distant recurrences due to locally advanced rectal cancer, with a consensual increase in overall survival. Even if surgery still remains the mainstay of treatment, for patients with stage II or III rectal cancer, available data support the use of neo-adjuvant chemoradiotherapy followed by radical resection. In the neo-adjuvant setting, novel biologic agents targeting aberrant pathways in rectal carcinogenesis are currently under study. This review describes the multidisciplinary management of rectal cancer, focusing on evidences supporting this approach and on the ongoing research to improve these regimens.