From the Pritzker School of Medicine, University of Chicago Medical Center, Chicago, IL
Authors’ disclosures of potential conflicts of interest are found at the end of this article.
Address reprint requests to Bruce D. Minsky, MD, Associate Dean and Professor of Radiation and Cellular Oncology, Pritzker School of Medicine, Chief Quality Officer, University of Chicago Medical Center, 5841 South Maryland Ave MC 1000, Chicago IL 60637; e-mail: bruce.minsky{at}uchospitals.edu
Overview: The conventional treatment for cT3 Nany rectal cancer is preoperative therapy. In most countries, this includes chemotherapy plus concurrent radiation (CMT). In Scandinavia and most Northern European countries, the treatment depends on the preoperative magnetic resonance imaging (MRI) assessment of the radial margin. In general, if the radial margin will likely be negative at the time of surgery, patients undergo surgery alone or receive 5 Gy x 5. If it is likely to be positive, patients will receive preoperative therapy with either 5 Gy x 5 or CMT. One of the unintended consequences of preoperative therapy is the potential for overtreatment. Retrospective data suggest that patients with pN0 disease who have undergone a total mesorectal resection and have at least 12 negative nodes have a marginal benefit in local control from the radiation component of CMT. Can patients with pN0 disease be accurately identified before surgery? In addition to improved imaging, is the distance from the anal verge a surrogate marker for the incidence of negative nodes and, therefore, local recurrence? This review will examine whether all patients with cT3 disease require preoperative therapy and whether the distance from the anal verge can help guide this decision.
