Rectal cancer restaging after neoadjuvant chemoradiation: towards a down-staging score system

We have read with great interest the article of Singhal et al. (1) and we agree with their conclusions. It is our policy to submit the patients affected by rectal cancer, T3 and T4, independently from N, to a neoadjuvant treatment with 50 Grays and FOLFOX chemotherapy. Surgery follows after 4–5 weeks, and it is preceded by a restaging procedure. In order to classify the down-staging of rectal tumors, we have adopted a score system (Table 1), inspired to the current TNM classification and based on imaging criteria, usually acquired with the common contrast-enhanced radiological tools, such as computed tomography (CT) and magnetic resonance (MR). We have also considered that tumor regression follows a preferential centripetal way, starting from its most peripheral zones toward the centre of the mass and to the site of deeper penetration.