title: Adjuvant treatment for locally advanced rectal cancer patients after preoperative chemoradiotherapy: when, and for whom?
abstract: BACKGROUND
  The standard treatment for patients with locally advanced rectal cancer (clinical tumor, node, metastases [TNM] stage II or III) is radiotherapy before surgery (with or without concomitant fluoropyrimidine-based chemotherapy) followed by surgery. The role of adjuvant chemotherapy in this setting of patients is controversial in terms of the overall benefit on survival, the subgroup of patients who might not need it, and the best regimen (combination regimens vs. fluoropyrimidine alone).
  
  
  METHODS
  Based on the retrospective analysis of the clinical outcome of all patients with locally advanced rectal adenocarcinoma treated at our institute during the past 9 years, we comment on prognostic factors for local and distant metastases of patients who received neoadjuvant treatment followed by surgery, and the scientific evidence that can help to decide the adjuvant chemotherapy.
  
  
  RESULTS
  We conclude that pathological TNM stage after neoadjuvant chemoradiation (ypTNM) stage after surgery significantly affects disease-free and overall survival. In particular, patients with pathologically positive lymph nodes (ypN+) after surgery have a high probability of developing distant metastases.
  
  
  CONCLUSIONS
  ypN+ patients are candidate for intensified adjuvant chemotherapy.
authors: Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy.
authors: Alfonso
authors: A
authors: De Stefano
authors: Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy.
authors: Roberto
authors: R
authors: Moretto
authors: Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy.
authors: Luigi
authors: L
authors: Bucci
authors: Department of Medicine, University of Salerno, Baronissi, Italy.
authors: Stefano
authors: S
authors: Pepe
authors: Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy.
authors: Francesco Jacopo
authors: FJ
authors: Romano
authors: Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy.
authors: Alessandra Chiara
authors: AC
authors: Cella
authors: Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy.
authors: Laura
authors: L
authors: Attademo
authors: Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy.
authors: Mario
authors: M
authors: Rosanova
authors: Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy.
authors: Stefano
authors: S
authors: De Falco
authors: Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy.
authors: Giovanni
authors: G
authors: Fiore
authors: Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy.
authors: Lucia
authors: L
authors: Raimondo
authors: Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy.
authors: Sabino
authors: S
authors: De Placido
authors: Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy. Electronic address: chiara.carlomagno@unina.it.
authors: Chiara
authors: C
authors: Carlomagno
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000069287:Capecitabine; D059186:Chemoradiotherapy, Adjuvant; D017024:Chemotherapy, Adjuvant; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use*; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D018579:Patient Selection; D012004:Rectal Neoplasms / Q000473:pathology* / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D000964:Antimetabolites, Antineoplastic; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D003841:Deoxycytidine; D000069287:Capecitabine; D005472:Fluorouracil
keywords: Adjuvant chemotherapy; Lymph nodes; Preoperative chemoradiotherapy; Prognostic factors; Rectal cancer