A randomised trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer

Bujko, Krzysztof

doi:10.1186/isrctn38817884

Cited by 36 publications

(57 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Two trials (Polish, TROG 01.04) have randomised between preoperative 5 × 5 Gy and preoperative CRT (5-FU + 50.4 Gy) without detecting any statistically signifi cant difference in local recurrence rates, DFS and OS. In the Polish trial [ 18 ], local recurrence rates were 11 % in the 5 × 5 arm at 4 years and 16 % in the CRT arm ( p = 0.2). The corresponding fi gures were 7.5 and 4.4 % ( p = 0.2) in the Australasian trial [ 19 ].…”

Section: Intermediate 'Bad' Rectal Cancersmentioning

confidence: 97%

Radiotherapy and Chemoradiation for Rectal Cancer: State of the Art in Europe, the USA and Asia

Glimelius

2014

Multidisciplinary Treatment of Colorectal Cancer

View full text Add to dashboard Cite

In rectal cancer treatment, not only the local primary but also regional and systemic tumour deposits must be taken care of. The three major treatments, surgery, radiotherapy and drugs, each with their own advantages and limitations, must be combined to result in improved outcomes. Several large randomised trials, reviewed here, have proven that combinations of the three modalities have markedly improved the locoregional problem, but not yet had any major infl uence on the systemic problem, and thus overall survival. The best integration of the so far weakest modality, the drugs, is not known. The results of the trials are interpreted differently in the world. A new generation of trials exploring the best sequence of treatments, together with integration of the novel drugs, is required.

show abstract

Section: Intermediate 'Bad' Rectal Cancersmentioning

confidence: 97%

Radiotherapy and Chemoradiation for Rectal Cancer: State of the Art in Europe, the USA and Asia

Glimelius

2014

Multidisciplinary Treatment of Colorectal Cancer

View full text Add to dashboard Cite

show abstract

“…19 Yet, downstaging 'per se' may not influence DFS or OS. 20 The Polish trial and the TROG trial demonstrate that the interval to pathological assessment influences the rate of response. The amount of downstaging and the pCR is very different in SCPRT with immediate surgery and CRT after a delayed interval , and the lack of nodal downstaging in the SCPRT arm has no impact on outcome -whereas it does in the CRT arm.…”

Section: For Debatementioning

confidence: 99%

The D Prefix

Glynne‐Jones

West

Quirke

2015

Diseases of the Colon &Amp; Rectum

View full text Add to dashboard Cite

“…[27][28][29] Although size may diminish, 30 no reduction in tumour or nodal classification is expected if the interval is less than 10 days. 31 Yet, some downstaging is observed if surgery is delayed for more than 10 days.…”

Section: 24mentioning

confidence: 99%

“…The routine blanket use of either SCPRT or CRT, as recommended on publication of the CR07 trial, represents substantial overtreatment. In this setting, current evidence from trials that compared SCPRT and preoperative CRT suggests that the two approaches are broadly similar in their ability to lower the risk of LR, 28,29 so both are acceptable options. Both approximately halve the rate of LR but do not impact on DFS or OS.…”

Section: Selection Of Patients Most Likely To Benefit From Preoperatimentioning

confidence: 99%

How to Select for Preoperative Short-course Radiotherapy, While Considering Long-course Chemoradiotherapy or Immediate Surgery, and Who Benefits?

Glynne-Jones¹,

Dt²,

Moran³

et al. 2014

European Oncology &Amp; Haematology

View full text Add to dashboard Cite

The management of patients with locally advanced rectal cancer (LARC) has evolved with the aim of reducing local recurrence and improving survival. Current practice has developed from refinements in surgical technique, the availability of different types of preoperative imaging, the selective or blanket use of neoadjuvant treatment (usually radiation) and sophisticated efforts exploring multimodality treatments to achieve organ preservation. Both short-course preoperative radiotherapy (SCPRT) and long-course chemoradiation (CRT) are considered standard neoadjuvant strategies, which are advocated in different parts of the world. New techniques in the delivery of radiotherapy, such as intensity-modulated radiotherapy (IMRT), may allow more precise dosing to the target volume (tumour and/or locoregional lymph nodes) and limit radiation doses to critical normal structures; however, current schedules of SCPRT and CRT impact on late function, and if they do not improve survival in resectable cancers, can they be omitted in selected cases? KeywordsRectal adenocarcinoma, neoadjuvant radiation, chemoradiation, chemotherapy, short-course preoperative radiation, long-course chemoradiation Disclosure: Rob Glynne-Jones has received honoraria for lectures and advisory boards and has been supported in attending international meetings in the last five years by Eli Lilly, Merck, Pfizer, Sanofi-Aventis and Roche. He has received unrestricted grants for research from Merck-Serono, Sanofi-Aventis and Roche. He is principal investigator of a randomised phase II neoadjuvant chemotherapy study in the UK called BACCHUS. David Tan In patients with locally advanced rectal cancer (LARC), not involving the mesorectal fascia (MRF), surgery with total mesorectal excision (TME) is the standard of care. Prior to the TME era, high rates of local recurrence (LR) were observed after radical surgery, and 10-40 % of patients required a permanent stoma, even for tumours arising in the mid/upper rectum. In the 1990s, randomised trials 1-3 established shortcourse preoperative pelvic radiotherapy (SCPRT) using 5 x 5 Gy as a component of the curative treatment of resectable and early rectal cancers. These historical trials reported LR rates of 20-30 % after surgery alone, reflecting the suboptimal surgical practice at the time.Two subsequent trials examined whether SCPRT simply compensated for poor surgical technique, i.e. whether SCPRT still reduced LR if TME was performed. By then, it was recognised that the risk of LR, after a potentially curative resection, is mainly explained by microscopic tumour cells within 1 mm of the circumferential resection margin (CRM). 4 Hence, in the control group in the event of a histopathological involved CRM, postoperative RT or chemoradiotherapy was intended in the Dutch TME study 5 and CR07 trial,6 respectively. Both trials confirmed a reduction in LR, but overall survival (OS) was not improved, and the risk of metastases predominated over LR. [5][6][7][8] During the same period, the strategy of postoperativ...

show abstract

A randomised trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer

Cited by 36 publications

References 0 publications

Radiotherapy and Chemoradiation for Rectal Cancer: State of the Art in Europe, the USA and Asia

Radiotherapy and Chemoradiation for Rectal Cancer: State of the Art in Europe, the USA and Asia

The D Prefix

How to Select for Preoperative Short-course Radiotherapy, While Considering Long-course Chemoradiotherapy or Immediate Surgery, and Who Benefits?

Contact Info

Product

Resources

About