Do We Have to Treat All T3 Rectal Cancer the Same Way?

Clin Colorectal Cancer. 2020 Dec;19(4):231-235. doi: 10.1016/j.clcc.2020.07.005. Epub 2020 Jul 24.

Abstract

Chemoradiotherapy (CRT) followed by surgery is the recommended approach in the last years for stage II and III rectal cancer with the intention to decrease the risk of local recurrence. However, fewer patients benefit from this strategy in terms of overall survival and long-term adverse outcomes because T3 rectal cancer has a broad range of prognosis, as shown by recent publications. Many patients with cT3 rectal cancer have a substantial risk of overtreatment with long-term toxicity related to radiotherapy that could be avoided in a subset group of cT3 tumors with good prognosis. These findings raised the question of whether all cT3 rectal cancer should receive preoperative radiotherapy and if a selected cT3 subgroup could be treated by surgery alone. This review addresses the rationale of selecting good prognosis cT3 rectal cancer for surgery alone and analyzes the data to support this recommendation.

Keywords: MRI; Neoadjuvant treatment; Radiotherapy; Rectal cancer treatment; Surgery.

Publication types

  • Review

MeSH terms

  • Chemoradiotherapy, Adjuvant / methods
  • Chemoradiotherapy, Adjuvant / standards*
  • Chemoradiotherapy, Adjuvant / statistics & numerical data
  • Clinical Decision-Making*
  • Disease-Free Survival
  • Humans
  • Neoadjuvant Therapy / methods
  • Neoadjuvant Therapy / standards*
  • Neoadjuvant Therapy / statistics & numerical data
  • Neoplasm Recurrence, Local
  • Neoplasm Staging
  • Patient Selection
  • Practice Guidelines as Topic
  • Proctectomy / standards*
  • Proctectomy / statistics & numerical data
  • Prognosis
  • Rectal Neoplasms / diagnosis
  • Rectal Neoplasms / mortality
  • Rectal Neoplasms / therapy*