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JNCI Journal of the National Cancer Institute 2000 92(5):361-362; doi:10.1093/jnci/92.5.361
© 2000 by Oxford University Press
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Journal of the National Cancer Institute, Vol. 92, No. 5, 361-362, March 1, 2000
© 2000 Oxford University Press

EDITORIALS

Defining the Optimal Therapy for Rectal Cancer

Daniel G. Haller

Correspondence to: Daniel G. Haller, M.D., Department of Medicine, University of Pennsylvania Cancer Center, 16 Penn Tower, 3400 Spruce St., Philadelphia, PA 19104 (e-mail: dhaller@mail.med.upenn.edu).

For physicians trained in the United States, postoperative combined modality therapy has become the accepted standard for patients with rectal cancer who are at high risk for locoregional and distant recurrence. In 1990, the results of two randomized trials demonstrating improved survival for postoperative chemotherapy with radiation therapy compared with either surgery alone or with postoperative radiation therapy alone led to an National Institutes of Health Consensus Conference recommendation that all patients with stage II or III rectal cancer should receive postoperative combined modality therapy. Two subsequent intergroup trials have retained control arms of postoperative radiation therapy with 5-fluorouracil-based chemotherapy, perpetuating the role of such treatment in clinical practice. However, there is not universal agreement that high-risk patients require all three modalities of therapy—surgery, radiation therapy, and chemotherapy—or even the proper order of such therapy. There is widespread use of preoperative radiation therapy given without chemotherapy in Europe. At least . . . [Full Text of this Article]

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