Consensus Recommendation (from the 11th Conference of the European Federation for Colorectal Cancer): Adjuvant Chemotherapy after Neoadjuvant Chemoradiotherapy for Rectal Cancer and TME Surgery

Chemoradio therapy followed by total mesorectal excision is the standard of care for rectal cancer. Although locoregional recurrence and survival have improved, distant recurrence has not. Adjuvant chemotherapy might prevent distant metastases, however, its use for patients with rectal cancer treated with preoperative radiochemotherapy and surgery is largely debated. Available data do not support its routine use in these settings, unlike in colon cancer where adjuvant therapy role is well established. According to ESMO Guidelines, adjuvant chemotherapy after preoperative radiochemo therapy with postoperative histology stage III and high-risk stage II can be considered (level of evidence is lower than in colon cancer). These consensus recommendations have been developed based on the review of current evidence and expert opinions, and are expected to assist in selecting subgroups of patients that could benefit from adjuvant chemotherapy after neoadjuvant radio chemotherapy and TME surgery and choosing chemotherapeutic agent in different post-operative scenarios.