Adverse effects of neoadjuvant chemoradiotherapy for postoperative course in rectal cancer

Abstract

Although preoperative chemoradiotherapy (CRT) is used to reduce the risk of local recurrence in patients with rectal cancer, toxic effect of CRT to the surrounding normal healthy tissues remains major drawback. Radiation-induced injury is classified as either acute (early) or chronic (late) one, and patients with radiation therapy for rec-tal cancer can have chronic disease of gastrointestinal tract. Therefore, CRT has known to be negative impact for wound healing, and could cause anastomotic leakage(AL)in patients with rectal cancer. However, several meta-analyses have indicated that CRT for rectal cancer does not increase AL because we usually delay operation after CRT, and construct protective stoma to prevent AL. On the other hand, AL after CRT is difficult to cure due to in-hibition of wound healing mechanism. In the future, developments of new drugs as sensitizer of CRT and radiation modality are urgently needed to decrease adverse effects of CRT, and to achieve complete tumor response for watch and wait therapy in rectal cancer.