title: Clinically-staged T3N0 rectal cancer: is preoperative chemoradiotherapy the optimal treatment?
abstract: BACKGROUND
  Preoperative chemoradiotherapy has been widely adopted as the standard of care for stage II-III rectal cancers. However, patients with T3N0 lesions had been shown to have a better prognosis than other categories of locally advanced tumor. Thus, neoadjuvant chemoradiation is likely to be overtreatment in this subgroup of patients. Nevertheless, the low accuracy rate of preoperative staging techniques for detection of node-negative tumors does not allow to check this hypothesis. We analyzed a group of patients with cT3N0 low rectal cancer who underwent neoadjuvant chemoradiotherapy with the purpose of evaluating the incidence of metastatic nodes in the resected specimens.
  
  
  METHODS
  Between January 2002 and February 2008, 100 patients with low rectal cancer underwent clinical staging by means of endorectal ultrasound, computed tomography, positron emission tomography, and magnetic resonance imaging. All patients received preoperative 5-fluorouracil-based chemoradiotherapy and surgical resection with curative aim.
  
  
  RESULTS
  Of 100 patients with locally advanced rectal cancer, 32 were clinically staged as T3N0M0. Pathological analysis showed the presence of lymph node metastases in nine patients (28%) (node-positive group). In the remaining 23 cases, clinical N stage was confirmed at pathology (node-negative group). Node-positive and node-negative groups differ only in the number of ypT3 tumors (P < .01).
  
  
  CONCLUSIONS
  Our results indicate that immediate surgery for patients with cT3N0 rectal cancer represents an undertreatment risk in at least 28% of cases, making necessary the use of postoperative chemoradiotherapy. Preoperative chemoradiotherapy should be the therapy of choice on the grounds of the principle that overtreatment is less hazardous than undertreatment for cT3N0 rectal cancers.
authors.affiliation: General Surgery Unit, S.Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Lombardi
authors.forename: Dajana
authors.initials: D
authors.lastname: Cuicchi
authors.forename: Carmine
authors.initials: C
authors.lastname: Pinto
authors.forename: Francesca
authors.initials: F
authors.lastname: Di Fabio
authors.forename: Bruno
authors.initials: B
authors.lastname: Iacopino
authors.forename: Stefano
authors.initials: S
authors.lastname: Neri
authors.forename: Maria Lucia
authors.initials: ML
authors.lastname: Tardio
authors.forename: Claudio
authors.initials: C
authors.lastname: Ceccarelli
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Lecce
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Ugolini
authors.forename: Sara
authors.initials: S
authors.lastname: Pini
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Di Tullio
authors.forename: Mario
authors.initials: M
authors.lastname: Taffurelli
authors.forename: Francesco
authors.initials: F
authors.lastname: Minni
authors.forename: Andrea
authors.initials: A
authors.lastname: Martoni
authors.forename: Bruno
authors.initials: B
authors.lastname: Cola
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D011300:Preoperative Care; D011379:Prognosis; D011879:Radiotherapy Dosage; D012004:Rectal Neoplasms / Q000473:pathology* / Q000628:therapy*; D015996:Survival Rate
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D005472:Fluorouracil