Radiotherapy in colorectal cancer

Radiotherapy in colonic cancer is limited to the palliative situation in most circumstances. It is used for painful bone metastases, skin secondaries, and occasionally for tumours with local infiltration into surrounding organs. The mobile nature of the colon makes it impossible to deliver multiple fractions of treatment to anatomically defined regions of the colon.

Conversely, the rectum is immobile and fixed within the pelvis and therefore a suitable target for radiotherapy. Radiotherapy has been used in both the pre-operative and post-operative setting in this disease.

In the pre-operative situation there are a group of patients (10-15%) who present with large fixed or tethered tumours that are non-resectable. Only half of this group will have distant metastases at presentation. The conversion rate to resectability is 35-75%, with a dose of 50-60 Gy given over a five-week period. This group is also often offered combined chemo-irradiation, though the precise benefits (or otherwise) of this approach are not yet known. The successful use of radiotherapy in this situation has helped promote it, even in those with initially resectable cancers.

♦ Local recurrence of rectal cancer in up to half of patients

♦ 13 trials—comparing surgery alone with surgery plus radiotherapy

♦ Data conflicting—local recurrence less

♦ Survival unchanged

♦ Post-operative radiotherapy for 4 weeks—less recurrence —no difference in survival

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