A 45 year male has rectal cancer 10 cm anal verge. MRI t3 no, crircumferential resection margin (crm free) has upfront anterior resection. Histology comes back as t3 node positive crm free. He shall receive postoperative adjuvant chemotherapy. Should he receive postoperative radiotherapy.?
Consensus regarding postoperative radiotherapy was in a non TME era, or when MRI was not used routinely for staging. Is there enough evidence to give postoperative radiotherapy in tumors where crm is free
Dear P Saklani
Fist,The pathologist should say whether the tumor is under peritoneal reflection .
The second,CRM could be negative but negativeness should be 2 mm and more .
Under reflection or mesorectum and surgical margine status determne RT choice.
Please take a look our Istanbul R-01 randomised study.
This is a good question, I had a similar query in a patient with a low rectal cancer who had an AP resection .The consensus with this was to offer postop radiotherapy to reduce risk of local relapse even though margins were clear. I think the rationale is that even if a complete TME has been performed, if there are positive nodes or close (but clear) margins, then there is a risk of local recurrence. TME would not have cleared the iliac nodes, a potential source of recurrence. I hope that is helpful. If you need further info including studies, then let me know. My review on neoadjuvant chemoradiation in rectal cancer refers to some of these issues, linked below.
http://www.ncbi.nlm.nih.gov/pubmed/21617242
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