This protocol covers rectal cancer clinically staged as T3 with any nodal status (N any) and a clear circumferential resection margin confirmed by MRI, or staged T1–2 with regional nodal involvement (N1–2). Two distinct treatment courses are recommended for this staging group.
Patients who meet one of the following staging criteria:
Total neoadjuvant therapy (TNT) is the preferred treatment course for this group, integrating systemic chemotherapy with chemoradiotherapy in sequence before definitive surgery. A second recognised option follows a more traditional perioperative structure with both neoadjuvant and adjuvant components. The full protocol specifies regimen selection, sequencing, and timing for each path.
The primary target is complete clinical response — no evidence of residual disease on digital rectal examination, rectal MRI, and direct endoscopic evaluation — assessed at restaging approximately 8 weeks after completion of radiotherapy.
T3, N any with clear circumferential resection margin (CRM) (by MRI); T1–2, N1–2
Clear CRM: Greater than 1 mm from mesorectal fascia and levator muscles and not invading into the intersphincteric plane.
Two potential treatment courses are recommended for this group of patients: either TNT followed by transabdominal resection or a more traditional perioperative therapy approach, including both neoadjuvant and adjuvant therapy.
TOTAL NEOADJUVANT THERAPY (PREFERRED)
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