The multidisciplinary rectal cancer treatment: Main convergences, controversial aspects and investigational areas which support the need for an European Consensus

Can CT Replace MRI in Preoperative Assessment of the Circumferential Resection Margin in Rectal Cancer?

“…The strategy of neoadjuvant chemoradiotherapy is based on preoperative identification of risk factors for local tumor recurrence. 11 Patients with anticipated tumor invasion of the MRF in MRI receive long courses of neoadjuvant chemotherapy and radiotherapy to downstage/downsize the tumor and to obtain tumor-free resection margins. 11 However, pelvic radiotherapy causes significant functional and perioperative complications and ideally is avoided in patients with early-stage disease.…”

“…Tumor relationship to the MRF and MRF invasion is efficiently determined by MRI. [11][12][13][14] Compared with MRI, multidetectorrow CT (MDCT) is more widely available, quicker, less costly, 15 and provides the ability to assess the liver, peritoneum, and retroperitoneum for metastases. However, only a few studies have been published that consider the role of MDCT in the current diagnostic workup of rectal cancer patients.…”

“…16 Thus, MRI has become the de facto standard for circumferential margin evaluation. MRI has proven effective in determining the relationship of the tumor to the MRF, 7,8,10,11,13,14,22 and is the best available reference standard for evaluating the accuracy of MDCT in the prediction of tumor invasion of the MRF.…”

Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer

“…Conventionally fractionated chemoradiation might be better than the short-course radiation schedule at reducing local recurrences. Another advantage of chemoradiation is better sphincter preservation because the tumour bulk is reduced before surgery 17,18 . However, there is no firm evidence to support this 18 .…”

Surgeon perspectives on the use and effects of neoadjuvant chemoradiation in the treatment of rectal cancer: a comprehensive review of the literature

“…Some initial reports and reviews have suggested an improved rate of sphincter preservation with neoadjuvant chemoradiotherapy as compared to adjuvant therapy [45]. Multiple studies have investigated this as a secondary outcome in trials designed for another primary outcome variable; however, few have been designed for the primary outcome of SP [31,46].…”