AJCC: American Joint Committee on Cancer; CT: computed tomography; CRT: chemoradiation; EUS: endoscopic ultrasound; M: metastasis; MRI: magnetic resonance imaging; MSS: microsatellite stable; N: node; pMMR: proficient mismatch repair; RT: radiation therapy; T: tumor.
* Clinical T1N0 and clinical T2N0 tumors are primarily managed with surgical resection (ie, transanal local excision, transabdominal resection).
Neoadjuvant CRT is an alternative for patients with a primary distal tumor who decline resection or are poor surgical candidates.
¶ Adjuvant therapy is indicated for clinical T1-2, N0 tumors treated with transabdominal resection that subsequently demonstrate pathologic T3-4 or pathologic N1-2 disease on postoperative pathology.
Δ Patients with a complete clinical response to total neoadjuvant therapy may be offered surveillance without further surgery.
◊ Neoadjuvant chemotherapy plus response-guided use of RT allows most patients to omit RT and avoid its late toxicities. Patients treated with neoadjuvant chemotherapy who have a clinical response of 20% or greater for the primary tumor can omit RT and proceed directly to surgical resection, whereas those with a clinical response of less than 20% receive neoadjuvant CRT or RT prior to surgery.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟