A Systematic Overview of Radiation Therapy Effects in Rectal Cancer

Glimelius, Bengt; Grönberg, Henrik; Järhult, Johannes; Wallgren, Arne; Cavallin‐Ståhl, Eva

doi:10.1080/02841860310012301

Cited by 250 publications

(145 citation statements)

References 24 publications

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“…This trial confirmed an additional benefit of neoadjuvant short-term radiotherapy even in combination with TME with a reduction of the local relapse rate to only 2.4% at 2 years and 5.8% at 5 years. Others have reported high local recurrence rates up to 17% (Kockerling et al, 1998;Camma et al, 2000;Colorectal Cancer Collaborative Group, 2001;Glimelius et al, 2003;Bosset et al, 2005). This discrepancy can be explained by the heterogeneity of the surgery, because TME was not yet widely applied, and by the variable use of 5FU-based chemoradiotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…Since the introduction of total mesorectal excision (TME) which includes the resection of the entire mesorectal fascia, local recurrences are reported in 5 -17% of the patients, depending on the experience of the centre, of the surgeon and whether neoadjuvant treatment has been applied or not (Janjan et al, 1998;Kockerling et al, 1998;Kapiteijn et al, 2001;Glimelius et al, 2003;Bosset et al, 2005;Engel et al, 2005;Gerard et al, 2005;Marijnen et al, 2005). This is in sharp contrast to former conventional surgery without additional treatment options, which were associated with local recurrence rates of up to 40% (Pahlman and Glimelius, 1990;MacFarlane et al, 1993).…”

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confidence: 99%

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CPT-11 and concomitant hyperfractionated accelerated radiotherapy induce efficient local control in rectal cancer patients: results from a phase II

et al. 2006

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Patients with rectal cancer are at high risk of disease recurrence despite neoadjuvant radiochemotherapy with 5-Fluorouracil (5FU), a regimen that is now widely applied. In order to develop a regimen with increased antitumour activity, we previously established the recommended dose of neoadjuvant CPT-11 (three times weekly 90 mg m À2 ) concomitant to hyperfractionated accelerated radiotherapy (HART) followed by surgery within 1 week. Thirty-three patients (20 men) with a locally advanced adenocarcinoma of the rectum were enrolled in this prospective phase II trial (1 cT2, 29 cT3, 3 cT4 and 21 cN þ ). Median age was 60 years (range 43 -75 years). All patients received all three injections of CPT-11 and all but two patients completed radiotherapy as planned. Surgery with total mesorectal excision (TME) was performed within 1 week (range 2 -15 days). The preoperative chemoradiotherapy was overall well tolerated, 24% of the patients experienced grade 3 diarrhoea that was easily manageable. At a median follow-up of 2 years no local recurrence occurred, however, nine patients developed distant metastases. The 2-year disease-free survival was 66% (95% confidence interval 0.48 -0.83). Neoadjuvant CPT-11 and HART allow for excellent local control; however, distant relapse remains a concern in this patient population.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

CPT-11 and concomitant hyperfractionated accelerated radiotherapy induce efficient local control in rectal cancer patients: results from a phase II

et al. 2006

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“…Starting full dose chemotherapy at an earlier stage has the advantage of treating micrometastatic disease earlier, thereby reducing the incidence of distant recurrence. Further more in most studies radiotherapy has not improved survival but primarily reduced local recurrence (1). Thus an alternative could be neoadjuvant chemotherapy alone.…”

Section: Neoadjuvant Chemotherapymentioning

confidence: 99%

“…In many large studies radiotherapy has reduced the incidence of LR but its effect on survival is not so clear (1,(80)(81)(82)(83). It was thus our ambition to analyse FXYD-3 expression in tumours from rectal cancer patients that developed a local recurrence and to see if these tumours have a strong FXYD-3 expression, or if strong FXYD-3 expression is related to time to LR.…”

Section: Fxyd-3 Expressionmentioning

confidence: 99%

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Response to neoadjuvant treatment in rectal cancer surgery

Loftås

2016

Linköping University Medical Dissertations

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Rectal cancer is one of the three most common malignancies in Sweden with an annual incidence of about 2000 cases. Current treatment consists of surgical resection of the rectum including the loco-regional lymph nodes in the mesorectum. In advanced cases, neoadjuvant chemo-radiotherapy (CRT) prior to the operative treatment reduces local recurrences and enables surgery. The neoadjuvant treatment can also eradicate the tumour completely, i.e. complete response. This research project was designed to investigate the effects of preoperative radiotherapy/ CRT and analyze methods to predict response to CRT. Study I investigated the expression of the FXYD-3 protein with immunohistochemistry in rectal cancer, with or without preoperative radiotherapy. The results from the total cohort showed that, strong FXYD-3 expression was correlated to infiltrative tumour growth (p = 0.02). In the radiotherapy group, strong FXYD-3 expression was related to an unfavourable prognosis (p = 0.02). Tumours with strong FXYD-3 expression had less tumour necrosis (p = 0.02) after radiotherapy. FXYD-3 expression in the primary tumour was increased compared to normal mucosa (p=0.008). We concluded that FXYD-3 expression was a prognostic factor in patients receiving preoperative radiotherapy for rectal cancer. Study II investigated FXYD-3 expression in tumours that developed local recurrences following surgery and compared this with expression in tumours that did not develop local recurrences. There was no difference in the expression of FXYD-3 between the group that developed local recurrences and the group that did not develop local recurrences. There was no difference in survival between those with strong or weak FXYD-3 expression. We concluded that this study could not confirm the findings from study 1 i.e. that FXYD-3 expression has prognostic significance in rectal cancer. Study III was a register-based study on the incidence and effects of complete response to neoadjuvant treatment. Eight per cent of the patients with adequate CRT to achieve complete response also had a complete histological response of the luminal tumor in the resected bowel. Sixteen per cent of that group had remaining lymph node metastases in the operative specimen. Chemotherapy together with radiotherapy doubled the chance of complete response in the luminal tumour. Patients with remaining lymph node metastases had a lower survival rate compared to those without. We concluded that residual nodal involvement after neoadjuvant treatment was an important factor for reduced survival after complete response in the luminal tumour. Study IV followed up the results from the previous study by re-evaluating magnetic resonance imaging (MRI)- images in patients with complete tumour response. Two experienced MRI radiologists performed blinded re-staging of post CRT MR- images from patients with complete response in the luminal tumour. One group with lymph node metastases and another one without were studied and the results compared with the pathology reports. The sensitivity, spe...

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