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Will Adjuvant Chemotherapy Improve Outcome After Preoperative Chemoradiation?

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Multidisciplinary Management of Rectal Cancer

Abstract

Adjuvant systemic chemotherapy is standard therapy in many patients with colon cancer since it can prevent recurrences and thus improve survival. The benefits, shown in randomized trials, are sufficiently large for routine use if the recurrence risk is at least reasonably high. Since colon and rectal cancer are regarded as one disease entity essentially separated only by an arbitrary anatomical border, adjuvant chemotherapy should improve outcome also in rectal cancer. Thus, the role of adjuvant chemotherapy in rectal cancer following chemoradiotherapy and surgery is frequently extrapolated from colon cancer without too much consideration of the scientific support for this approach. However, there are biological differences beyond anatomical location between these tumour types; the preoperative (chemo)radiotherapy adds complexity with bearing on the role of adjuvant chemotherapy and, most disturbingly, there is lack of convincing data showing a benefit from adjuvant chemotherapy in rectal cancer. This is particularly the case after preoperative chemoradiation. There is a great need for well-designed trials to answer the fundamental question whether adjuvant chemotherapy in rectal cancer provides any benefit after preoperative chemoradiation.

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Authors and Affiliations

  1. Department of Radiology, Oncology and Radiation Science, University of Uppsala, Akademiska sjukhuset, SE-751 85, Uppsala, Sweden

    Bengt Glimelius & Peter Nygren

  2. Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden

    Bengt Glimelius

Authors
  1. Bengt Glimelius
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  2. Peter Nygren
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Correspondence to Bengt Glimelius .

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Editors and Affiliations

  1. , Dept. of Radiation Therapy, Università Cattolica S.Cuore, Largo A.Gemelli 8, Rome, 00168, Italy

    Vincenzo Valentini

  2. Klinik und Poliklinik Innere Medizin IV, Abt. Hämatologie und Onkologie, Universitätsklinikum Halle-Wittenberg, Ernst-Grube-Str. 40, Halle, 06097, Sachsen-Anhalt, Germany

    Hans-Joachim Schmoll

  3. Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, Netherlands

    Cornelis J. H. van de Velde

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Glimelius, B., Nygren, P. (2012). Will Adjuvant Chemotherapy Improve Outcome After Preoperative Chemoradiation?. In: Valentini, V., Schmoll, HJ., van de Velde, C. (eds) Multidisciplinary Management of Rectal Cancer. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-25005-7_22

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  • DOI: https://doi.org/10.1007/978-3-642-25005-7_22

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