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©2014 Baishideng Publishing Group Inc.
World J Gastroenterol. Dec 14, 2014; 20(46): 17279-17287
Published online Dec 14, 2014. doi: 10.3748/wjg.v20.i46.17279
Published online Dec 14, 2014. doi: 10.3748/wjg.v20.i46.17279
Table 2 Clinical management of rectal cancer according to risk categories[2]
Risk group | Management |
Very early (some cT1) | Local excision (TEM)If poor prognostic characteristics are present, (such as high grade, vascular invasion, etc), TME resection (or possibly CRT) can be considered |
Early (cT1-2, some cT3), or “good” | Surgery alone (TME) is sufficient, and should result in a few rate of local recurrences (< 3%-4% after 5 yr)If poor prognostic characteristics are present, such as circumferential margin or nodal involvement, post-operative CRT or CT can be added |
Intermediate (cT3- some cT4a), or “bad” | Surgery alone results in a high rates of local recurrences (> 8%-10% after 5 yr if surgery alone)Add preoperative RT (5 × 5 Gy) or CRT followed by TMEIf cCR is obtained with CRT, wait-and-see policy may be considered in selected cases (such as high risk patients for surgery) |
Locally advanced (cT3crm +, some cT4a, all cT4b), or “ugly” | Preoperative CRT is needed to achieve high probability of R0 surgery (TEM) and a decrease of local recurrencesPreoperative 5 × 5 Gy RT with a delay to surgery can be considered in elderly or in patients with severe comorbidity who cannot tolerate CRT |
- Citation: Berardi R, Maccaroni E, Onofri A, Morgese F, Torniai M, Tiberi M, Ferrini C, Cascinu S. Locally advanced rectal cancer: The importance of a multidisciplinary approach. World J Gastroenterol 2014; 20(46): 17279-17287
- URL: https://www.wjgnet.com/1007-9327/full/v20/i46/17279.htm
- DOI: https://dx.doi.org/10.3748/wjg.v20.i46.17279