Adjuvant radiation for rectal cancer: when and with what?

This review outlines the progress made in recently reported trials to establish an effective adjuvant treatment for the surgical management of rectal cancer. Many of the trials of preoperative and postoperative radiation conducted over the past two decades are now mature. Moderate-to-high doses of radiation given prior to or following surgery reduce pelvic tumor recurrence rates but have little effect on survival. The coupling of radiation with cytotoxic chemotherapy, particularly 5-fluorouracil-based protocols, has been reported to improve survival as well as reduce the risk of recurrence in the pelvis and elsewhere. The status of ongoing trials is outlined.