Historically, rectal cancer with transmural spread and/or lymph node involvement has presented a major challenge to surgeons. It has a variable and often high risk of local recurrence and poor survival outcomes.
In recent years a large amount of literature has focused attention on the importance of surgical technique, tumor staging, and the optimal integration of CT and radiation therapy.
In this study, researchers reviewed clinical trials that define the current approach to rectal cancer.
|Staging can be improved with the use of endorectal ultrasound and magnetic resonance imaging.|
|Diseases of the Colon and Rectum|
The results of their study are published in the March issue of Diseases of the Colon and Rectum.
The research team determined that the preoperative staging of rectal cancer can be improved with the use of endorectal ultrasound and magnetic resonance imaging.
In addition, careful pathologic analysis, particularly of the radial margin, provides important prognostic information that enables better allocation of postoperative care.
Radiation therapy and CT have a proven role in adjuvant therapy. However, the interpretation of many studies is confounded by unacceptably poor outcomes in the control arm, and in older studies the use of inferior chemotherapy and radiation therapy techniques.
The team also found that ongoing studies will better define the optimal combination and timing of chemotherapy and radiation therapy, with respect to both toxicity and survival endpoints.
Dr James Church’s team concluded, “A combined modality approach to rectal cancer, integrating the colon and rectal surgeon, pathologist, medical oncologist, and radiation oncologist, is necessary to achieve optimal outcomes”.
“The achievements to date and the ongoing vigorous debates regarding standard care continue to highlight the importance of quality ongoing research in a rapidly changing clinical environment.”