Chemotherapy and radiotherapy in the treatment of colorectal cancer

Colorectal cancer is the second most common cause of cancer-related death in men and women In the ‘developed’ world. One-third of these patients will present with advanced disease and a further one-third will relapse after surgical removal of the primary cancer. Adjuvant chemotherapy in Dukes C colorectal cancers is well established in reducing the risk of death and improves five-year survival by up to 10%. Its role in Dukes B tumours remains unclear, but there appears to be a small benefit, particularly in patients with high-risk disease. Palliative chemotherapy with a fluoropyrimidine-based regimen improves survival compared to best supportive care in patients with metastatic disease. New agents such as irinotecan and oxaliplatin have become established in the care of these patients. Novel targeted agents such as bevacuzimab and cetuximab can be combined with standard chemotherapy and appear to improve survival further. The optimal sequence in which these agents are used remains unclear and is under further evaluation in clinical trials. Radiotherapy is important in the management of rectal tumours and reduces local recurrence rates even after total mesorectal excision. Chemoradiation in locally advanced disease can render tumours operable and may be used in patients unsuitable for surgery. There have been many advances in the management of colorectal cancer and a detailed assessment by the multidisciplinary team is required to ensure optimal treatment.