Rectal Cancer

Question 1

Staging

Answer 1

T1 – submucosa

T2 – muscle-invasive

T3 – invading the subserosa

T4 – serosa

N1 = 1-3 lymph nodes

N2 = 4+ lymph nodes

Question 2

Post-op Studies

Answer 2

GITSG 7175

NSABP R01

SNABP R02

Gist is that RT reduces LR by 1/3 but has no OS benefit. Chemo does have a benefit of 1/3 and does impact OS.

patients who go to surgery and actually have T3 disease need adjuvant therapy

Question 3

Dutch Study

Answer 3

Preoperative Study

Question 4

MRC Study

Answer 4

Preoperative Study

Improvement in LC 11% -> 4%, 6% benefit in DFS (though these patients had early stage disease)

Post-hoc analysis revealed that positive margins are still bad after RT

No benefit in stage I patients

Question 5

German rectal trial

Answer 5

preop vs post-op

More adherence to chemo in the preop group

Question 6

EORTC 22921

Answer 6

Neoadjuvant therapy with RT alone vs chemoRT

No difference in OS with the addition of chemo to preop therapy, only LC!!

Question 7

ADORE

Answer 7

5FU vs FOLFOX in pts with yp stage II/III disease

benefit with adjuvant treatment in those with yp stage III disease

Question 8

Habr Gama IJROBP 2014

Answer 8

183 pts s/p chemoRT with stage I-III

90/183 had a pCR, of which 31 % had pelvic recurrence

You could still do salvage surgery at recurrence