LAUSR

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.