A 62-year-old man undergoes resection for a rectal carcinoma 6 cm from the anal verge. Histology shows T3 N2 M0. According to current guidelines for locally advanced rectal cancer, the preferred sequence of treatment is:

• A Upfront surgery followed by adjuvant chemotherapy alone
• B Long-course chemoradiotherapy (LCRT) followed by total mesorectal excision (TME) after 8–12 weeks ✓
• C Short-course radiotherapy (25 Gy in 5 fractions) followed by immediate surgery
• D Adjuvant chemoradiotherapy only after R0 resection

Explanation

For cT3-T4 or N+ mid-low rectal cancers, the international standard is neoadjuvant long-course chemoradiotherapy (50.4 Gy with concurrent capecitabine or 5-FU) followed by TME at 8–12 weeks to allow tumour downsizing, downstaging, and assess for clinical complete response. Short-course RT is equivalent for resectable cases but LCRT is preferred when sphincter preservation or pCR is prioritised. Upfront surgery without neoadjuvant therapy is not standard for T3N2 rectal cancer.

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.