Preoperative Radiotherapy Has No Value for Patients with T2–3, N0 Adenocarcinomas of the Rectum

Abstract

Background: Treatment of rectal cancer with preoperative radiotherapy followed by total mesorectal excision is nowadays the standard treatment. It reduces local recurrences and improves overall survival. However, in patients with T2–3, N0 rectal cancer, the role of preoperative radiotherapy remains controversial. The aim of this study was to review the benefit of radiotherapy in T2 and T3, N0 rectal cancer patients. Methods: Between 1996 and 2003, 103 patients with T2–3, N0 rectal cancer were identified in our prospective database. This study evaluated time to local recurrence, distant metastases and overall survival. Results: Median follow-up was 4.3 years. The 5-year local control rate was 94%. The 5-year overall survival was 65%. The 5-year disease-free survival rate was 82%. Preoperative radiotherapy did not show any statistical differences. Abdominal perineal resection and T3 tumors negatively influenced overall survival (p = 0.02). Advanced age was of significant importance in overall survival. Conclusions: Preoperative radiotherapy does not seem to be of significant importance in patients with T2–3, N0 rectal cancer regarding local recurrence and survival. Since preoperative radiotherapy is associated with short- and long-term morbidity, patients with T2–3, N0 tumors should be identified and treated with surgery alone.

The impact of general/visceral obesity on completion of mesorectum and perioperative outcomes of laparoscopic TME for rectal cancer

“…Researchers suggested it should be not necessary to perform neoadjuvant or adjuvant radiotherapy on CRM negative cases according to preoperative evaluation. Ferenschild et al [ 36 ] found that T2–3N0 patients did not benefit from neoadjuvant radiotherapy (local recurrence rate: 6% vs 6% P > 0.05). Taylor et al [ 37 ] reported 5-year local recurrence rate was only 3% for T2/T3a/T3b and CRM negative patients without neoadjuvant radiotherapy.…”

Nomograms to predict survival and the risk for developing local or distant recurrence in patients with rectal cancer treated with optional short-term radiotherapy

“…Several reports suggest that the effect of (neo)adjuvant therapy depends on factors such as TNM stage, tumour position, surgical technique, biological behaviour as well as on patient characteristics [10][11][12][13][14]. A more personalized approach, tailored to these factors, might improve the balance between beneficial and adverse effects of (neo)adjuvant treatment and allow better patient selection.…”

Identification of Locally Advanced Rectal Cancer with Low Risk of Local Recurrence

“…Since neoadjuvant CRT only reduces risk of local recurrence but not distant metastases [ 10 ], and inevitably results in short-term and long-term toxicities [ 11 ], some studies questioned the strategy of routine application of neoadjuvant CRT to patients with T3N0 rectal cancer, and proposed that only those at high risk of local recurrence should be treated with neoadjuvant CRT [ 2 , 12 ].…”