A 60-year-old man with a T3N1M0 mid-rectal cancer (6 cm from anal verge) on staging MRI. The MERCURY trial and current ESMO guidelines recommend which preoperative treatment strategy?
- A Short-course radiotherapy (5×5 Gy) followed by immediate surgery within 1 week
- B Long-course chemoradiotherapy (50.4 Gy + concurrent 5-FU) followed by TME after 8-12 weeks ✓
- C Immediate TME without neoadjuvant therapy as T3N1 is operable
- D FOLFOX chemotherapy alone followed by assessment for TME
Correct answer: B. Long-course chemoradiotherapy (50.4 Gy + concurrent 5-FU) followed by TME after 8-12 weeks
Explanation
For locally advanced rectal cancer (T3-4 and/or N+) that is not clearly resectable with adequate CRM on MRI, standard of care is long-course chemoradiation (45-50.4 Gy with concurrent 5-FU or capecitabine) followed by TME after 8-12 weeks to allow maximal tumour downsizing and downstaging. The MERCURY study validated MRI-based CRM prediction for surgical planning. Total neoadjuvant therapy (TNT) protocols with upfront FOLFIRINOX followed by chemoradiotherapy are emerging as alternatives to improve pathological complete response rates.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.