Chemoradiation for localized rectal cancer: Neoadjuvant versus adjuvant approaches

For many years, adjuvant postoperative chemotherapy and radiation has been the standard of care in the United States for patients with T3, T4, or node-positive rectal cancer. Preoperative chemoradiation has generally been reserved for situations in which a response to therapy would allow for sphincter-preserving surgery. Recent data support the use of chemoradiation in the preoperative setting, demonstrating improvements in tumor downstaging, treatment toxicity, rate of sphincter-preserving surgery, and pelvic recurrence.