Adjuvant and neoadjuvant treatment of resectable, locally advanced, rectal carcinoma with radiation therapy and chemotherapy.

Patients who undergo apparently curative low anterior or abdominal-perineal resection of locally advanced carcinoma of the rectum have a significant rate of local pelvic recurrence and death from cancer in the years following surgery. Pre- and postoperative irradiation and chemotherapy in various combinations and schedules have been recommended to improve the outcome for these patients. Several randomized trials have evaluated the effectiveness of adjuvant and neoadjuvant treatments in improving survival and reducing the rate of pelvic recurrence with a combination of radiation and chemotherapy. There is some evidence that preoperative treatment with radiation is more effective than postoperative treatment. The treatment program preferred at Ochsner is described.