Treatment of newly diagnosed locally advanced rectal adenocarcinoma (cT3-4Nx, TxN1-2)
Treatment of newly diagnosed locally advanced rectal adenocarcinoma (cT3-4Nx, TxN1-2)
This is an overview of our approach to the management of newly diagnosed locally advanced (cT3-4 or node positive) rectal adenocarcinoma. It should be used in conjunction with other UpToDate content on rectal adenocarcinoma.
MRI: magnetic resonance imaging; EUS: endoscopic ultrasound; CT: computed tomography; FDG-PET: fluorodeoxyglucose positron emission tomography; RT: radiation therapy. * cT3 invades through the muscularis propria into pericolorectal tissues. ¶ CT is appropriate for all.
If pelvic MRI has been done, we perform CT of the chest and abdomen
If pelvic MRI has not been done, we perform CT of the chest, abdomen, and pelvis
Δ At some institutions, total neoadjuvant therapy (induction chemotherapy plus long-course chemoradiotherapy, or induction chemotherapy with short-course RT) is offered to all patients with locally advanced rectal cancer. ◊ Patients who refuse surgery or are considered poor surgical candidates after chemoradiotherapy may be managed by full thickness local excision after chemoradiotherapy. Highly selected patients who appear to have a complete clinical response (scar only) may be considered for full thickness local excision or "watch and wait", but should understand that transabdominal surgery represents a standard approach in this setting. More extensive residual disease at the time of local excision should prompt reconsideration for transabdominal surgery.
§ In most centers, all patients who undergo neoadjuvant chemoradiotherapy are offered adjuvant chemotherapy due to difficulty in assessing nodal status in the treated surgical specimen. Postoperative chemotherapy is omitted for those who receive at least four months of chemotherapy prior to chemoradiotherapy.
