Short-course radiation versus long-course chemoradiation for rectal cancer: Making progress

摘要

There are two broad approaches to preoperative pelvic radiation therapy for resectable rectal cancer: short-course radiation and long-course chemoradiotherapy. Although the radiation techniques are similar, the fractionation and timing of surgery differ. In general, short-course radiation delivers 25 Gy (5 Gy in five fractions) of radiation followed by surgery 1 week later. Long-course chemoradiotherapy delivers 50.4 Gy (1.8 Gy in 28 fractions) of radiation concurrently with chemotherapy, followed by surgery 4 to 8 weeks later. These competing approaches evolved in parallel; short-course radiation developed in northern Europe and Scandinavia and long-course chemoradiotherapy in the United States and selected European countries. Advocates for each approach base their unwavering enthusiasm on the results of three large randomized trials that were published during the last 15 years.