[Rectal carcinoma: is too much neoadjuvant therapy performed? Proposals for a more selective MRI based indication]

Zentralbl Chir. 2006 Aug;131(4):275-84. doi: 10.1055/s-2006-946549.
[Article in German]


The present-day optimised surgery (concept of total mesorectal excision) with quality assurance by standardized pathologic examination, advances in radiotherapy and the possibilities of high-spatial-resolution MR imaging require reconsideration of pros and contras of neoadjuvant therapy and respective data. According to the resulting new proposal neoadjuvant long-course radiochemotherapy is indicated for patients with 1) fixed questionably R0 resectable tumors, 2) mobile tumors with the MRT finding of tumor involving the mesorectal fascia or 1 mm or less from it, 3) low rectal tumors extending below the levator origin and invading beyond the muscularis propria. If a high risk of local recurrence becomes apparent during surgery (tumor perforation, incision into or through tumor) or after pathologic examination (incomplete mesorectal excision, tumor 1 mm or less from the circumferential resection margin) adjuvant radiochemotherapy is indicated. In case of lymph node metastasis postoperative chemotherapy is given.

Publication types

  • Comparative Study
  • English Abstract
  • Review

MeSH terms

  • Combined Modality Therapy
  • Humans
  • Lymphatic Metastasis
  • Magnetic Resonance Imaging*
  • Meta-Analysis as Topic
  • Neoadjuvant Therapy* / adverse effects
  • Neoplasm Recurrence, Local
  • Neoplasm Staging
  • Postoperative Care
  • Radiotherapy Dosage
  • Randomized Controlled Trials as Topic
  • Rectal Neoplasms / diagnosis
  • Rectal Neoplasms / drug therapy
  • Rectal Neoplasms / mortality
  • Rectal Neoplasms / pathology
  • Rectal Neoplasms / radiotherapy
  • Rectal Neoplasms / surgery*
  • Rectum / pathology
  • Risk Factors
  • Time Factors