Modern irradiation techniques. What is the benefit of intensity modulated radiotherapy (IMRT) for rectal cancer?

Radiotherapy is one of the three fundamental modalities in the multimodal treatment of patients with locally advanced rectal cancer. Due to the good overall prognosis, therapy-related side effects play an important role in the long-term quality of life of these patients. An optimized treatment including modern irradiation techniques, such as intensity modulated radiotherapy (IMRT) could lead to lower doses to the organs at risk and therefore help to protect against chronic toxicity, especially with respect to intensified therapy regimens. This article outlines the role of modern radiotherapy within multimodal treatment concepts of rectal cancer and the importance of an optimized course of therapy and the technical development of irradiation techniques are discussed. As only very few long-term data for IMRT of rectal cancer exist, a possible effect on tumor response and the occurrence of side effects are discussed also based on the results of other tumor entities. In summary a significant benefit of the new techniques for the treatment of rectal is self-evident. The multimodal treatment of rectal cancer should be performed under standardized and optimized conditions. Based on the initial data and experience with other tumor entities, the widespread introduction of IMRT could help to reduce both acute and chronic side effects in the treatment of rectal cancer patients without compromising tumor control. For a final assessment, additional long-term data from controlled studies and larger patient numbers are needed.