Table 4.

Rectal cancer: Adjuvant treatment.

Topic	NCCN a Recommendations	ESMO b Recommendations	JSCCR c Recommendations
Stage I	None after transabdominal resection	None	None
Stage II & III	Chemotherapy +/− RT Observation is an option for certain T3N0 tumours located in the upper rectum	Postoperative CRT, combined with additional 4 months of adjuvant bolus 5FU. Routine use of CRT has been questioned if a good quality TME can be assured. After surgery alone, consider adjuvant 5FU/leucovorin +/− oxaliplatin	Consider adjuvant chemotherapy in Stage II with high risk of recurrence Adjuvant chemotherapy in Stage III Preoperative RT for patients with cT 3-4 or cN + status Postoperative radiotherapy for patients with pT3-4 or pN + status, where the existence of a surgical dissection plane positive (RM1) or penetration of the surgical dissection plane by the cancer (RMX) is unclear

Adapted with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) for Guideline Rectal Cancer V.1.2022. © 2022 National Comprehensive Cancer Network, Inc. All rights reserved. The NCCN Guidelines^® and illustrations herein may not be reproduced in any form for any purpose without the express written permission of NCCN. To view the most recent and complete version of the NCCN Guidelines, go online to NCCN.org. The NCCN Guidelines are a work in progress that may be refined as often as new significant data become available; 5FU = 5-fluorouracil; RT = radiotherapy; SCRT = short course radiotherapy; CRT = chemoradiotherapy; ^a NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) [14]; ^b European Society of Medical Oncology (ESMO) guidelines [15]; ^c Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines [18].