Klin Onkol 2020; 33(Suppl 1): 38-47. DOI: 10.14735/amko2020S38.
Background: Currently, surgery is still the only reliable curative procedure at all stages of rectal cancer. Its early stage involving the submucosa may be most effectively managed by local and gentle surgical procedures, without oncology therapy. However, most patients have deeper invading tumors that require radical transabdominal surgery. A large part of these tumors are locally advanced; they need a comprehensive solution consisting of a combination of surgery, radiotherapy and chemotherapy. The surgical and oncology treatment of these patients depends on the stage and location of the rectal tumor. The main goal of radiotherapy is to reduce the risk of local recurrences. Despite evident advances in the treatment, several issues remain unclear. The main subject of discussion is currently the best method of radiotherapy, the sequence of treatment modalities, as well as surgical approach to patients who achieve a clinical complete response after neoadjuvant treatment. The quality of life is considered to be a significant factor in assessing the therapeutic success in addition to the oncological outcome. Radiotherapy does not have the same benefit for all patients with advanced rectal cancer; in addition, it is necessary to take account of its adverse effects, especially late ones. According to current recommendations, radiotherapy may be omitted in some cases, particularly in upper rectal tumors. The tumors in the lower third of the rectum are a difficult issue. This is the main therapeutic challenge in terms of local control and preservation of the anal sphincter. Purpose: The aim of this paper is to summarize the basic knowledge about radiotherapy of rectal cancer and relevant results of clinical trials and to highlight some controversial or unresolved issues.
