The good, the bad and the ugly: rectal cancers in the twenty-first century
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In the management of rectal cancer with neoadjuvant treatment followed by surgery, pre-operative chemoradiation used to be directed by the risk of development of local recurrence. In this setting, risk-stratification restricted the indications for neoadjuvant treatment for patients with high-risk (“ugly”) or intermediate risk (“bad”) tumors based on distance from circumferential resection margin (CRM), depth of mesorectal invasion, presence of lymph node metastases or extramural venous invasion. However, with the opportunity for organ-preserving strategies following complete response to neoadjuvant therapy, restriction of neoadjuvant treatment exclusively to high/moderate risk rectal cancers would significantly limit the amount of patients that could potentially benefit from this approach. Current trends have suggested that neoadjuvant treatment benefits patients with earlier stages of rectal cancer (previously considered “good” tumors) most likely develop complete response. It may...
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