[Rectal carcinoma: is too much neoadjuvant therapy performed? Proposals for a more selective MRI based indication].
The present-day optimised surgery (concept of total mesorectal excision) with quality assurance by standardized pathologic examination, advances in radiotherapy and the possibilities of high-spatial-resolution MR imaging require reconsideration of pros and contras of neoadjuvant therapy and respective data. According to the resulting new proposal neoadjuvant long-course radiochemotherapy is indicated for patients with 1) fixed questionably R0 resectable tumors, 2) mobile tumors with the MRT finding of tumor involving the mesorectal fascia or 1 mm or less from it, 3) low rectal tumors extending below the levator origin and invading beyond the muscularis propria. If a high risk of local recurrence becomes apparent during surgery (tumor perforation, incision into or through tumor) or after pathologic examination (incomplete mesorectal excision, tumor 1 mm or less from the circumferential resection margin) adjuvant radiochemotherapy is indicated. In case of lymph node metastasis postoperative chemotherapy is given.
Junginger
Th
T
Klinik für Allgemein- und Abdominalchirurgie, Klinikum der Johannes Gutenberg- Universität Mainz. sekretariat@ach.klinik.uni-mainz.de
Hermanek
P
P
Oberholzer
K
K
Schmidberger
H
H
D003131:Combined Modality Therapy; D006801:Humans; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D015201:Meta-Analysis as Topic; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011182:Postoperative Care; D011879:Radiotherapy Dosage; D016032:Randomized Controlled Trials as Topic; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D012007:Rectum / Q000473:pathology; D012307:Risk Factors; D013997:Time Factors