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PURPOSE: The determination of the best therapeutic approach in extraperitoneal rectal cancer patients is very complex
both in the neoadjuvant/adjuvant and the metastatic setting. We tried to identify and summarize the current methods
of diagnosis, staging and treatment from a multidisciplinary approach.
METHODS: Five sections can be indentified: diagnosis and staging; neoadjuvant treatment; adjuvant treatment; liver metastases
treatment and local recurrence therapy. Data were collected from international guidelines (NCCN) and MEDLINE
search. The main aim was the identification of the beast diagnostic and therapeutic approach in extraperitoneal rectal
cancer patients in case of local recurrence and metastatic disease.
RESULTS: Data from 2010 NCCN guidelines and 48 articles published in major international oncologic reviews were
collected and evaluated from 1993 up to 2009. Three articles dealt with staging procedures, 24 dealt with neoadjuvant
and adjuvant therapy; 18 were about with liver metastases and 3 about local recurrence treatment.
CONCLUSIONS: The correct disease staging is necessary for pursuing the best therapeutic approach and it should involve
different radiological techniques in order to evaluate the clinic TNM. Neoadjuvant treatment (chemo-radiotherapy) should
be considered for stage II and stage III extraperitoneal rectal cancer patients, followed by post-operative adjuvant chemotherapy.
Patients who underwent surgery and have a post-operative stage II or III disease, have to receive four months
of adjuvant chemotherapy after surgical resection. Initial treatment options of asymptomatic patient with resectable liver
metases include systemic chemotherapy in order to obtain downstaging of the primary tumor and liver metastase shrinking
followed by resection.
The treatment of local recurrence is mainly surgical. If not previously administered, radiotherapy represents an alternative