Adjuvant therapy may be underutilized in patients with clinical T2N0 rectal adenocarcinoma, according to new findings presented at Digestive Disease Week 2024.

T2N0 rectal adenocarcinoma spreads past the submucosa into the muscularis propria but has not spread to other organs or structures. Current recommendations from the National Comprehensive Cancer Network suggest patients with this type of cancer do not require adjuvant therapy to reduce the risk of cancer recurrence. 

“NCCN Guidelines indicate that patients who are diagnosed with [clinical] T2N0 … rectal [adenocarcinoma] should undergo surgery directly. However, this becomes a challenge when [clinical] T2N0 disease becomes upstaged to pathologic T3N0, as there are no clear management guidelines for adjuvant treatment,” said lead study author Simran Kripalani, MD, a general surgery resident at Temple University Hospital in Philadelphia.

In the recent study presented at DDW, researchers examined 878 patients aged 18 years or older who received a diagnosis of clinical T2N0 rectal adenocarcinoma, underwent surgical resection, and were upstaged to pathologic T3N0 disease. They noted that the patients received either surgery alone, surgery and postoperative chemotherapy, surgery and postoperative chemoradiation, or surgery with chemotherapy plus separate radiation therapy.

The researchers found postoperative chemotherapy and chemotherapy with separate radiation therapy remained independently associated with improved overall survival compared with surgery alone. Further, 5-year survival was found to be lowest in the surgery-alone group (62.4%), whereas all of the other treatment groups ranged from 77% to 83.8%.

“The findings of this study lead us to believe that adjuvant therapy may currently be underutilized in this setting,” said Dr. Kripalani. “While these results provide us with valuable insight into the role of adjuvant treatment in this group of patients, additional research will have to be done to better understand when and how these strategies will provide patients with the most benefits,” she concluded.

No conflicts of interest were disclosed.