Adjuvant vs. neoadjuvant radiochemotherapy for locally advanced rectal cancer: the German trial CAO/ARO/AIO‐94

Abstract

The patient accrual to the trial is satisfactory. Neoadjuvant RCT is well tolerated and bears no higher risk for postoperative morbidity.

Local staging of rectal cancer using combined pelvic phased‐array and endorectal coil MRI

“…A well known result of preoperative chemoradiotherapy is downsizing of tumors and involved lymph nodes, which leads to a lower pathological staging (5)(6)(7)(8)(9). It is likely that the downstaging effect of preoperative chemoradiotherapy contributed to some of the false-positive results in our study, since all of the overstaged patients in terms of mesorectal fat invasion and the majority (six of eight) of the overstaged patients in terms of nodal involvement received preoperative radiochemotherapy.…”

“…It is likely that the downstaging effect of preoperative chemoradiotherapy contributed to some of the false-positive results in our study, since all of the overstaged patients in terms of mesorectal fat invasion and the majority (six of eight) of the overstaged patients in terms of nodal involvement received preoperative radiochemotherapy. However, this limitation is unavoidable because preoperative chemoradiotherapy is now the standard of care for presumed stage II/III cancers (8,9). If we had excluded the patients with stage II/III disease, we would have underestimated the accuracy, since MRI has been shown to be highly accurate in assessing advanced disease (11,46).…”

“…Twenty-six (51%) patients with MRI-based stage II or stage III tumors underwent preoperative chemoradiotherapy that consisted of 50.4 Gy external beam radiotherapy and two cycles of 5-FU (1000 mg/m 2 /d) (9). The mean time interval between the MRI and surgery in these patients was 14 weeks (range ϭ 9 -19 weeks).…”

“…Traditional surgical methods, such as low anterior resection (LAR) and abdominoperineal resection (APR), have high recurrence rates, leading to a poor prognosis (4). Recent findings from large, randomized trials indicate that preoperative chemoradiotherapy substantially reduces the frequency of local recurrence and improves survival (5)(6)(7)(8)(9). In addition, preoperative chemoradiotherapy may reduce the size of a tumor, facilitate a curative resection, and enable sphincter-preserving surgery in tumors located near the anorectal junction (6,7).…”

“…In addition, preoperative chemoradiotherapy may reduce the size of a tumor, facilitate a curative resection, and enable sphincter-preserving surgery in tumors located near the anorectal junction (6,7). Preoperative chemoradiotherapy is not offered for stage I tumors (confined to the rectal wall, no nodal involvement: T1-2/N0), but is recommended as a standard treatment for stage II (extent beyond the rectal wall, no nodal involvement: T3/N0) and stage III (regional lymph node involvement, regardless of T stage: Tx/N1-2) tumors (5,8,9). To avoid the morbidity of chemoradiation in patients with stage I tumor, a reliable imaging modality is necessary to accurately differentiate tumors confined to the rectal wall (T1-2) from tumors with mesorectal invasion (T3-4), and to identify lymph node involvement.…”