Adjuvant treatment for locally advanced rectal cancer patients after preoperative chemoradiotherapy: When, and for whom?

Alfonso De Stefano, Roberto Moretto, Luigi Bucci, Stefano Pepe, Francesco Jacopo Romano, Alessandra Chiara Cella, Laura Attademo, Mario Rosanova, Stefano De Falco, Giovanni Fiore, Lucia Raimondo, Sabino De Placido, Chiara Carlomagno

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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).

Patients and 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.

Conclusion ypN+ patients are candidate for intensified adjuvant chemotherapy.

Original languageEnglish
Pages (from-to)185-191
Number of pages7
JournalClinical Colorectal Cancer
Issue number3
Publication statusPublished - Sep 1 2014


  • Adjuvant chemotherapy
  • Lymph nodes
  • Preoperative chemoradiotherapy
  • Prognostic factors
  • Rectal cancer

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology
  • Medicine(all)


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