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Preoperative radiotherapy (RT) alone or in combination with a pre- or postoperative chemotherapy reduces the recurrence rate and increases the survival rate for patients with resectable rectal cancer. The therapeutic index, i.e. relationship between effects and side effects is objective of studies. Especially toxicities to the small intestine and to the sphincter function are evaluated. Preoperative radiotherapy achieves the best results. The treatment volume includes the mesorectum in case of continence maintaining surgery and includes the anal sphincter in case of abdominoperineal resection. To exclude the small intestine from the RT-field, we prefer the use of 3 or 4 field technique in a prone position with filled bladder, using an optimal field limitation. The Swedish study, which uses 25 Gy in five fractions per week leads to an increased rate of acute and late toxicities. A fractionation schedule using 45-50 Gy in five weeks should be preferred. During the radiotherapy the patient is followed-up once per week. If surgery is foreseen, it should take place as soon as 3 weeks after the end of radiotherapy. If a primary surgery is performed preoperatively, the operative finding should be discussed with the surgeon. Quality control programs have to certify optimal treatment of the patient by radiotherapist and surgeon.

Intracavitary contact radiotherapy was used according to the guidelines of J. Papillon in 91 patients with early rectal tumors (72 adenocarcinomas and 19 villous adenomas) at the Dijon Cancer Institute. Most of the patients were referred because of poor surgical risk. Ten patients had interstitial implants in addition, 96% of the patients had a complete response. The local control rate after five years was 74% (67/91). Including salvage the ultimate control rate was 91% (83/91). 85% (77/91) had preservation of the sphincter function. The size of the rectal cancer and the degree of rectal wall invasion were of prognostic impact as proposed by the clinical staging system of Dijon.