Recommandations pour la pratique clinique Cancer du rectum

The previous guidelines for the neoadjuvant treatment of rectal cancer have been published in 2005. The present updates have taken into account all last scientific publications. For T4, T3 tumours, an MRI is mandatory to assess the circumferential margin. No radiological exam can predict with accurary the nodal status.Neoadjuvant radiotherapy reduces the rate of local recurrence but alter the functionnal results as the sexual function after anterior resection. Resectable upper third rectal cancers don’t benefit from neoadjuvant treatment. For mid and lower third rectal cancers, indication for neoadjuvant treatment depends on the radiological explorations. Some tumours with a sufficient circumferential margin can be treated by immediate surgery. mrT3d or T4 tumours require neoadjuvant radiochemotherapy.Concomitant chemotherapy should be based only on oral 5-FU (Capecitabine). Intravenous 5-FU is an alternative. Other chemotherapy regimens are not indicated. After short course radiotherapy, the waiting period shoud not exceed 7 days. After radiochemotherapy, it seems not usefull to extend the waiting period longer than 6-8 weeks.