Adjuvant Therapy in Rectal Cancer: Analysis of Stage, Sex, and Local Control—Final Report of Intergroup 0114

Tepper, Joel E.; O’Connell, Michael J.; Niedzwiecki, Donna; Hollis, Donna; Benson, Al B.; Cummings, Bernard; Gunderson, L. L.; Macdonald, John S.; Martenson, James A.; Mayer, Robert J.

doi:10.1200/jco.2002.07.132

Cited by 289 publications

(139 citation statements)

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“…Distant failure rates of 30 -40% are consistently reported throughout all large phase II and III trials and account for the poor outcome of patients with locally advanced rectal cancer compared to patients with colon cancer (Sanfilippo et al, 2001;Marijnen et al, 2003b;Sauer et al, 2004). By 5 years, approximately one third of the patients will die of their disease mainly due to the occurrence of distant metastases (Tepper et al, 2002;Bosset et al, 2005;Marijnen et al, 2005).…”

Section: Discussionmentioning

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%

“…(4) Lastly, micrometastases should be eliminated early in the disease course. Indeed, rectal adenocarcinoma has a high invasive potential with up to 60% of patients presenting with systemic metastases (mainly lung and liver), either at initial diagnosis or during follow-up (Tepper et al, 2002).…”

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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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“…Tam doz KRT'ye rağmen %56 yedi yıllık sağkalım ve %17 lokal başarısızlık oranları saptanmıştır. [20] Ameliyat sonrası KRT uygulanacak olguların belirlenmesinde NCI konsensüs konferansında pT3/4 ve/veya nod pozitif olgular belirtilse de konsensüs raporunda bildirilen "tam küratif rezeksiyonla cerrahi uygulanmış" ibaresi dikkat edilmesi gereken bir vurgulamadır. [16] Rektum kanserinde cerrahi sonrası lokal kontrolü etkileyecek risk faktörleri değerlendirildiğinde cerrahi sınır payları, nodal hastalık durumunu değerlendirme metodu, cerrah ve kullandığı tekniğin önem arz ettiği fark edilmektedir.…”

Section: Tablounclassified

“…[20] Tüm dünyada kabul edilen standart radikal cerrahi şekli TME'dir. Cerrahın tekniği ve tecrübesi yapılan çalışmalar-da lokal kontrol ve sağkalımı etkileyen önemli bir prognostik faktör olarak saptanmıştır.…”

Section: Tablounclassified

Radiation therapy schedule for rectal cancer

Demircioğlu¹

2014

TJ Oncol

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Presently, rectal cancer requires a multimodality approach to therapy. In this scheme, radiation therapy may play an important role in increasing the local control rate, improving disease-free and overall survival rates, and protection of organ function. Many studies have been conducted to improve treatment response rates. Radiation therapy schedule is the most studied issues among them. The advantages and disadvantages of preoperative radiotherapy when compared to postoperative administration have been studied in several phase II and phase III studies. In addition, it has been demonstrated that the preoperative approach increases the local control rates with a reduction in acute and late toxicity. Preoperative radiotherapy can be either applied as long-term or short-term. The main advantage of the long-term approach is that it can be applied with concomitant chemotherapy which results in higher response rates and complete pathological reduction. The aim of this review article is to summarize the evidence in literature and determine the most appropriate form of radiotherapy in the management of rectal cancer.Key words: Preoperative radiotherapy; postoperative radiotherapy; rectal cancer.Rektal kanserler günümüzde multimodalite tedavi gerektiren bir kanser türüdür. Bu tedavi şeması içerisinde radyoterapi, lokal kontrol oranını artırmada, hastalıksız ve genel sağkalım sürelerini iyileştirmede ve organ fonksiyonu korunmasında önemli rol oynamaktadır. Tedavi cevap oranlarını artırmak için birçok çalışma yapılmıştır. Bunlar arasında en çok incelenen konuların başında radyoterapi zamanlaması gelmektedir. Ön-celeri lokal kontrol oranını artırmak amacı ile ameliyat sonrası uygulamalara karşı ameliyat öncesi uygulamaların avantaj ve dezavantajları gösterilmeye çalışılmıştır. Ameliyat öncesi uygulamalarda ise kısa ve uzun süreli uygulamalar incelenmiştir. Burada bu konuyla ilgili yapılan çalışmalar değerlendirilerek en uygun radyoterapi şekli ve zamanlamasının belirlenmesi amaçlanmıştır. Sonuç olarak lokal ileri evre rektal kanserli olgularda standart yaklaşım ameliyat öncesi uzun süreli kemoradyoterapi olarak kabul görmüştür. Kısa süreli radyoterapinin ameliyat sonrası radyoterapiye üstünlükleri gösterilse de uzun süreli kemo-radyoterapi ile kıyaslandığında ancak rezektabl kT3 kanserlerde bir alternatif olarak gözükmektedir.Anahtar sözcükler: Ameliyat öncesi radyoterapi; ameliyat sonrası radyoterapi; rektal kanser.

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“…Surgery remains the mainstay of treatment, but a high risk of local recurrence and poor survival (40 -55% at 5 years) has been reported even for patients with mobile/resectable rectal cancer despite a curative resection and postoperative CRT (Tepper et al, 2002). Despite improved local surgical and radiotherapeutic techniques, locoregional relapse is now exceeded by the rate of development of systemic metastases.…”

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Neoadjuvant chemotherapy prior to preoperative chemoradiation or radiation in rectal cancer: should we be more cautious?

et al. 2006

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Neoadjuvant chemotherapy (NACT) is a term originally used to describe the administration of chemotherapy preoperatively before surgery. The original rationale for administering NACT or so-called induction chemotherapy to shrink or downstage a locally advanced tumour, and thereby facilitate more effective local treatment with surgery or radiotherapy, has been extended with the introduction of more effective combinations of chemotherapy to include reducing the risks of metastatic disease. It seems logical that survival could be lengthened, or organ preservation rates increased in resectable tumours by NACT. In rectal cancer NACT is being increasingly used in locally advanced and nonmetastatic unresectable tumours. Randomised studies in advanced colorectal cancer show high response rates to combination cytotoxic therapy. This evidence of efficacy coupled with the introduction of novel molecular targeted therapies (such as Bevacizumab and Cetuximab), and long waiting times for radiotherapy have rekindled an interest in delivering NACT in locally advanced rectal cancer. In contrast, this enthusiasm is currently waning in other sites such as head and neck and nasopharynx cancer where traditionally NACT has been used. So, is NACT in rectal cancer a real advance or just history repeating itself? In this review, we aimed to explore the advantages and disadvantages of the separate approaches of neoadjuvant, concurrent and consolidation chemotherapy in locally advanced rectal cancer, drawing on theoretical principles, preclinical studies and clinical experience both in rectal cancer and other disease sites. Neoadjuvant chemotherapy may improve outcome in terms of disease-free or overall survival in selected groups in some disease sites, but this strategy has not been shown to be associated with better outcomes than postoperative adjuvant chemotherapy. In particular, there is insufficient data in rectal cancer. The evidence for benefit is strongest when NACT is administered before surgical resection. In contrast, the data in favour of NACT before radiation or chemoradiation (CRT) is inconclusive, despite the suggestion that response to induction chemotherapy can predict response to subsequent radiotherapy. The observation that spectacular responses to chemotherapy before radical radiotherapy did not result in improved survival, was noted 25 years ago. However, multiple trials in head and neck cancer, nasopharyngeal cancer, non-small-cell lung cancer, small-cell lung cancer and cervical cancer do not support the routine use of NACT either as an alternative, or as additional benefit to CRT. The addition of NACT does not appear to enhance local control over concurrent CRT or radiotherapy alone. Neoadjuvant chemotherapy before CRT or radiation should be used with caution, and only in the context of clinical trials. The evidence base suggests that concurrent CRT with early positioning of radiotherapy appears the best option for patients with locally advanced rectal cancer and in all disease sites where radiation is the primary l...

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Adjuvant Therapy in Rectal Cancer: Analysis of Stage, Sex, and Local Control—Final Report of Intergroup 0114

Cited by 289 publications

References 50 publications

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

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

Radiation therapy schedule for rectal cancer

Neoadjuvant chemotherapy prior to preoperative chemoradiation or radiation in rectal cancer: should we be more cautious?

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