Benefit from preoperative radiotherapy in rectal cancer treatment: disease-free patients' and oncologists' preferences

Abstract

Preoperative radiotherapy (PRT) in resectable rectal cancer improves local control but increases probability of faecal incontinence and sexual dysfunction. Consensus was reached in 2001 in the Netherlands on a guideline advising PRT to new patients. Purpose was to assess at what benefit oncologists and rectal cancer patients prefer PRT followed by surgery to surgery alone, and how oncologists and patients value various treatment outcomes. Sixty-six disease-free patients and 60 oncologists (surgical, radiation, medical) were interviewed. Minimally desired benefit from PRT (local control) was assessed using the Treatment Tradeoff Method. Importance of survival, local control, faecal incontinence, and sexual dysfunction in determining treatment outcome preferences was assessed using Adaptive Conjoint Analysis. The range of required benefit from PRT varied widely within participant groups. Seventeen percent of patients would choose PRT at a 0% benefit; 11% would not choose PRT for the maximum benefit of 11%. Mean minimally desired benefit excluding these two groups was 4%. For oncologists, the required benefit was 5%. Also, how strongly participants valued treatment outcomes varied widely within groups. Of the four outcomes, participants considered incontinence most often as most important. Relative treatment outcome importance differed between specialties. Patients considered sexual functioning more important than oncologists. Large differences in treatment preferences exist between individual patients and oncologists. Oncologists should adequately inform their patients about the risks and benefits of PRT, and elicit patient preferences regarding treatment outcomes.

Clinician and cancer patient views on patient participation in treatment decision-making: a quantitative and qualitative exploration

“…Participants were disease-free rectal cancer patients who had participated in a study assessing rectal cancer treatment preferences (Pieterse et al, 2007). For that study, a stratified random sample was selected from patients who had participated in a multicenter trial assessing the benefit of adding preoperative radiotherapy (PRT) to total mesorectal excision surgery between January 1996 and December 1999 (Kapiteijn et al, 2001).…”

Choosing between short-course preoperative radiotherapy and long-course chemoradiation therapy

“…However, we should be aware of the need for open and transparent discussion with patients in terms of effi cacy and long-term treatment toxicity. The need for this approach was confi rmed by a recent study by Pieterse et al [47] seeking the opinions of 70 disease-free rectal cancer patients and 60 oncologists (surgical, radiation, and medical). One conclusion was that clinicians seemed reluctant to share information on the likely impact of adjuvant treatment.…”

Preclinical study of the DNA repair inhibitor Dbait in combination with chemotherapy in colorectal cancer

“…Secondly, Dbait molecules may also help to enhance tumor response in locally advancer rectal cancer in association with preoperative chemoradiotherapy. Preoperative chemoradiotherapy, particularly in 5-FU-based protocols [3], has already been combined with capecitabine, oxaliplatin, or irinotecan (CPT-11) and with targeted therapies in phase I-II trials in this last indication [8,52]. The local biodisponibility of Dbait could be improved by innovative formulations in the form of suppositories or by rectoscopy-assisted intratumoral injection.…”

“…In locally advanced rectal cancer, preoperative chemotherapy is used in combination with radiotherapy to improve local control, to favor tumor downstaging and to increase the possibility of being able to carry out sphincter-sparing surgical procedures [2][3][4]. Most chemotherapy protocols are based on the use of 5-fluorouracil (5-FU), which may be combined with other chemotherapy agents, such as irinotecan, oxaliplatin, and/or other targeted therapies [5][6][7][8].…”