title: Is adjuvant radiotherapy warranted in resected pT1-2 node-positive rectal cancer?
abstract: BACKGROUND
  Stage T1-2 rectal cancers are unlikely to have lymph node metastases and neoadjuvant therapy is not routinely administered. Postoperative management is controversial if lymph node metastases are detected in the resected specimen. We studied the outcomes of patients with pT1-2 node-positive rectal cancer in order to determine whether adjuvant radiotherapy was beneficial.
  
  
  METHODS
  We conducted a retrospective analysis of 284 patients with pathological T1-2 node-positive rectal cancer from a single institution. Outcomes, including local recurrence (LR), distant metastasis (DM), disease free survival (DFS) and overall survival (OS), were studied in patients with detailed TN staging and different adjuvant treatment modalities.
  
  
  RESULTS
  The overall 5-year LR, DM, DFS and OS rates for all patients were 12.5%, 32.9%, 36.4% and 76.8%, respectively. Local control was inferior among patients who received no adjuvant therapy. Patients could be divided into three risk subsets: Low-risk, T1N1; Intermediate-risk, T2N1 and T1N2; and High-risk, T2N2. The 5-year LR rates were 5.3%, 9.8% and 26.4%, respectively (p = 0.005). In High-risk patients, addition of radiotherapy achieved a 5-year LR rate of 9.1%, compared 34.8% without radiotherapy.
  
  
  CONCLUSIONS
  In our study, we provide the detailed outcomes and preliminary survival analysis in a relatively infrequent subset of rectal cancer. Three risk subsets could be identified based on local control for pT1-2 node positive rectal cancer. Postoperative treatment needs to be individualized for patients with pT1-2 node-positive rectal cancer.
authors.forename: Junjie
authors.initials: J
authors.lastname: Peng
authors.forename: Xinxiang
authors.initials: X
authors.lastname: Li
authors.forename: Ying
authors.initials: Y
authors.lastname: Ding
authors.forename: Debing
authors.initials: D
authors.lastname: Shi
authors.forename: Hongbin
authors.initials: H
authors.lastname: Wu
authors.affiliation: Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China. caisanjun@gmail.com.
authors.forename: Sanjun
authors.initials: S
authors.lastname: Cai
mesh_terms: D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D018714:Radiotherapy, Adjuvant / Q000379:methods*; D012004:Rectal Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D012306:Risk; D016896:Treatment Outcome