随机临床研究已证实辅助放化疗的作用，德国研究证实术前新辅助放化疗较术后化疗的优势。荷兰的TEM研究中显示肿瘤位置是影响治疗疗效的预后因素。但在具体化疗的实施和与化疗的联合应用，目前没有统一的共识。术前放疗的分割剂量，同期化疗应用和病人的选择存有差异。在治疗选择时需注意综合分析，多学科治疗模式。

Combined multimodality in the treatment of distal rectal cancer ZHANG Zhen. Department of Radiation Oncology, Cancer Hospital, Fudan University, Shanghai 200032,China Abstract German trial has showed the benefit of neoadjuvant chemoradiation compared with adjuvant chemoradiation in the management of rectal cancer and it has been the preference standard of care of stage II and III rectal cancer. Tumor location is known to be an important prognostic factor in results of treatment. Consensus are not reached in the treatment of distal rectal cancer, especially in the radiation style, short course vs long course; radiation alone or chemoradiation and patient selection. There is no universal model for the neoadjuvant chemoradition of distal rectal cancer. Multidisciplary approach and fully consideration should be taken.