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Adjuvant chemotherapy in rectal cancers: why a standard in the US and not in Europe?

Nature Clinical Practice Oncology volume 1, pages 58–59 (2004)Cite this article

In 1990, a US National Institutes of Health (NIH) Consensus Conference recommended postoperative chemoradiotherapy as standard treatment for stage II and III rectal cancer.1 The recommendations mean that, unless medical or psychosocial contraindications to treatment are present, patients should postoperatively receive 5-FU-based chemotherapy for about 6 months together with 5 to 6 weeks of radiation. The recommendations were further emphasized in an NCI Clinical Announcement in 1991 and since then repeatedly in many textbooks, reviews and in Patterns of Care studies.2 Even though there is a trend in the US to use more preoperative radiotherapy, particularly if sphincter preservation can be increased, adjuvant chemotherapy is the standard of care for rectal cancer in the US, although not uniformly adopted after preoperative radiochemotherapy.2,3 However, in a presently ongoing US Intergroup trial, E3201, rectal cancer patients who receive preoperative radiochemotherapy are all randomized to one of three chemotherapy regimens postoperatively. Since a response to the preoperative treatment greatly influences postoperative outcome, the choice of whether to give adjuvant chemotherapy and the type of adjuvant treatment ought to be influenced by whether or not a response was seen.

Many European centers and even some countries, such as Germany and Italy, have adopted the US recommendations as standard care. Therefore, it is inappropriate to state that adjuvant chemotherapy is not standard care in Europe. However, some countries and large collaborative study groups have opposed this recommendation, and still run trials comparing surgery alone, with or without preoperative radiotherapy and radiochemotherapy, and surgery plus postoperative chemotherapy.

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  1. Professor, Department of Oncology, Uppsala and Department of Oncology and Pathology, Radiology and Clinical Immunology, University Hospital, Karolinska University Hospital, Stockholm, Sweden

    Bengt Glimelius

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Correspondence to Bengt Glimelius.

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Glimelius, B. Adjuvant chemotherapy in rectal cancers: why a standard in the US and not in Europe?. Nat Rev Clin Oncol 1, 58–59 (2004). https://doi.org/10.1038/ncponc0042

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