Introduction

Rectal cancer represents a serious oncological problem because of its high frequency in Western countries (40 340 estimated new cases of rectal cancer in the USA in 2005, with estimated deaths of 56 290 people from colorectal cancer) with an increasing trend, and its high morbidity and mortality rate [1].

Surgery still has a major role in the treatment of patients affected with rectal cancer. Results of surgery are strictly correlated with the stage of the disease: depth of invasion of rectal wall and presence or absence of locoregional lymph node involvement. Survival at 5 years after curative rectal resection is 80% for patients in stage I, 50-60% for stage II and decreases to 30-40% for stage III cancer [2].

The main reason for failure after radical surgery in the group of patients with advanced rectal cancer is local recurrence that has an incidence reported in the literature ranging from 15 to 50% [3, 4].

Major sites of local failure are the presacral area, involving anastomosis (in low anterior resection), perineal skin (in abdominal perineal resection (APR)) and pelvic organs (bladder, vagina, prostate, etc). Radical resection of recurrence is possible in a limited number of cases, in which anastomosis only is involved, and APR or pelvic exenteration are technically feasible [5]. In other cases, where pelvic bones are infiltrated, use of palliative treatment is justified. These patients often suffer symptoms that are poorly responsive to medical therapy and mortality rates remain high.

During the past 20 years, several models of neoad-juvant or adjuvant treatment have been proposed for treatment of patients with rectal cancer (surgery differently combined with chemotherapy, radiotherapy (RT) or both), with the aim of improving overall and disease-free survival, and increasing the number of resections with free margins.

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