Preoperative neo-adjuvant therapy for curable rectal cancer - Reaching a consensus 2008

Abstract

Objectives: Our aim was to determine the range of neo-adjuvant therapy the multidisciplinary team (MDT) currently offers patients with curable (M0) rectal cancer. Method: A senior oncologist from each ofthe four oncology centres in north Wales and the north-west of England (approximate target population 8 million - Glan Clwyd, Clatterbridge, Christie and Preston) reviewed his/her understanding of the current evidence of neo-adjuvant therapy in rectal cancer. Then a representative from each centre was asked to identify which of three neo-adjuvant options (no neo-adjuvant therapy, short-course radiotherapy 25Gy over five fractions and long-course chemoradiotherapy) he/she would use for a rectal cancer in the upper, middle or lower third of the rectum staged by magnetic resonance imaging as being T2-T4 and/or N0-N2. Results: In all cases of locally advanced rectal cancer (T3a N1-T4), oncologists from the four oncology centres recommended long-course chemoradiotherapy before rectal resection. This consensus was maintained for cases of lower third T3a N0 cancers. Thereafter, the majority of patients with rectal cancer are offered adjuvant short-course radiotherapy. Conclusions: Neo-adjuvant therapy is less likely to be offered if the tumour is early (T2, N0) and/or situated in the upper third of the rectum. © 2009 The Authors. Journal compilation © 2009 The Association of Coloproctology of Great Britain and Ireland.