Annals of Surgical Oncology

, Volume 17, Issue 3, pp 838–845

Clinically-Staged T3N0 Rectal Cancer: Is Preoperative Chemoradiotherapy the Optimal Treatment?

Authors

  • Raffaele Lombardi
    • General Surgery UnitS.Orsola-Malpighi Hospital
  • Dajana Cuicchi
    • General Surgery UnitS.Orsola-Malpighi Hospital
    • Medical Oncology UnitS.Orsola-Malpighi Hospital
  • Francesca Di Fabio
    • Medical Oncology UnitS.Orsola-Malpighi Hospital
  • Bruno Iacopino
    • Radiotherapy UnitS.Orsola-Malpighi Hospital
  • Stefano Neri
    • Radiotherapy UnitS.Orsola-Malpighi Hospital
  • Maria Lucia Tardio
    • Pathology UnitS.Orsola-Malpighi Hospital
  • Claudio Ceccarelli
    • Pathology UnitS.Orsola-Malpighi Hospital
  • Ferdinando Lecce
    • General Surgery UnitS.Orsola-Malpighi Hospital
  • Giampaolo Ugolini
    • General Surgery UnitS.Orsola-Malpighi Hospital
  • Sara Pini
    • Medical Oncology UnitS.Orsola-Malpighi Hospital
  • Piergiorgio Di Tullio
    • Medical Oncology UnitS.Orsola-Malpighi Hospital
  • Mario Taffurelli
    • General Surgery UnitS.Orsola-Malpighi Hospital
  • Francesco Minni
    • General Surgery UnitS.Orsola-Malpighi Hospital
  • Andrea Martoni
    • Medical Oncology UnitS.Orsola-Malpighi Hospital
  • Bruno Cola
    • General Surgery UnitS.Orsola-Malpighi Hospital
Colorectal Cancer

DOI: 10.1245/s10434-009-0796-7

Cite this article as:
Lombardi, R., Cuicchi, D., Pinto, C. et al. Ann Surg Oncol (2010) 17: 838. doi:10.1245/s10434-009-0796-7

Abstract

Background

Preoperative chemoradiotherapy has been widely adopted as the standard of care for stage II–III rectal cancers. However, patients with T3N0 lesions had been shown to have a better prognosis than other categories of locally advanced tumor. Thus, neoadjuvant chemoradiation is likely to be overtreatment in this subgroup of patients. Nevertheless, the low accuracy rate of preoperative staging techniques for detection of node-negative tumors does not allow to check this hypothesis. We analyzed a group of patients with cT3N0 low rectal cancer who underwent neoadjuvant chemoradiotherapy with the purpose of evaluating the incidence of metastatic nodes in the resected specimens.

Methods

Between January 2002 and February 2008, 100 patients with low rectal cancer underwent clinical staging by means of endorectal ultrasound, computed tomography, positron emission tomography, and magnetic resonance imaging. All patients received preoperative 5-fluorouracil-based chemoradiotherapy and surgical resection with curative aim.

Results

Of 100 patients with locally advanced rectal cancer, 32 were clinically staged as T3N0M0. Pathological analysis showed the presence of lymph node metastases in nine patients (28%) (node-positive group). In the remaining 23 cases, clinical N stage was confirmed at pathology (node-negative group). Node-positive and node-negative groups differ only in the number of ypT3 tumors (P < .01).

Conclusions

Our results indicate that immediate surgery for patients with cT3N0 rectal cancer represents an undertreatment risk in at least 28% of cases, making necessary the use of postoperative chemoradiotherapy. Preoperative chemoradiotherapy should be the therapy of choice on the grounds of the principle that overtreatment is less hazardous than undertreatment for cT3N0 rectal cancers.

Copyright information

© Society of Surgical Oncology 2009