Changing strategy for rectal cancer is associated with improved outcome

Dahlberg, Mikael; Glimelius, Bengt; Påhlman, Lars

doi:10.1046/j.1365-2168.1999.01040.x

Cited by 164 publications

(69 citation statements)

References 17 publications

(7 reference statements)

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“…There has also been an increase in the use of preoperative radiotherapy (26), again with different starting points at different hospitals. Analyses have shown that survival for rectalcancer patients improved earlier in counties where the new treatments were first introduced (25). The better prognosis for rectal cancer compared with colon cancer observed during the most recent time periods is likely to be explained by improved treatment.…”

Section: Digestive Organsmentioning

confidence: 98%

“…For rectal cancer, surgery has improved substantially. Total mesorectal excision was introduced in one Swedish county in 1986 (25) and has been performed at almost all hospitals undertaking rectalcancer surgery in Sweden since the mid-1990s. There has also been an increase in the use of preoperative radiotherapy (26), again with different starting points at different hospitals.…”

Section: Digestive Organsmentioning

confidence: 99%

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Cancer Survival in Sweden 1960–1998 Developments Across Four Decades

et al. 2003

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Section: Digestive Organsmentioning

confidence: 98%

Section: Digestive Organsmentioning

confidence: 99%

Cancer Survival in Sweden 1960–1998 Developments Across Four Decades

et al. 2003

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“…The term 'total mesorectal excision' (TME) is often used for this type of surgery, although the entire mesorectum is not always excised in high rectal cancers. Concentration of rectal cancer surgery to a colorectal cancer unit and extensive surgical training programmes have also resulted in low local failure rates (approximately 10 Á/15% after 2 Á/5 years) in unselected Swedish patient populations (3,54) and in Norway (55). Several individual hospitals have also reported low recurrence rates after having introduced the TME concept (e.g.…”

Section: Radiotherapy In Resectable Rectal Cancermentioning

confidence: 99%

A Systematic Overview of Radiation Therapy Effects in Rectal Cancer

et al. 2003

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“…The recurrence rates among patients having had preoperative radiotherapy or surgery alone were 2% and 10%, respectively, indicating that radiotherapy affects the local recurrence rate, even if surgery is optimized (53). Data from Uppsala, Sweden revealed a recurrence rate of 3% when TME surgery was combined with preoperative radiotherapy (25 Gy in one week) (54).…”

Section: Is Adjuvant Radiotherapy Needed For the Treatment Of Rectal mentioning

confidence: 99%

Perioperative Radiotherapy in the Management of Rectal Cancer

Påhlman

2001

Canadian Journal of Gastroenterology

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Surgery for rectal cancer has resulted in unacceptably high local failure rates, and substantial morbidity and mortality. In an attempt to reduce the high frequency of local recurrence, perioperative radiotherapy has been used extensively, alone or in combination with chemotherapy. The local recurrence rate has been reduced dramatically with the use of radiotherapy, and provided that the dose is high enough and given preoperatively, the reduction rate has been about 50%. Despite that a higher dose is used in postoperative radiotherapy, the reduced recurrence rate is not that prominent. The reduced recurrence rate demonstrated after preoperative radiotherapy has a positive influence on survival, which has not been seen when radiotherapy is given postoperatively. However, when postoperative irradiation has been combined with chemotherapy, a survival benefit has been demonstrated. With modern radiation techniques, preoperative radiotherapy can be delivered without any substantial increase in postoperative mortality or morbidity, and a low rate of late toxicity, provided that the radiation technique is optimal. The main question is whether radiotherapy is necessary, provided that surgery is optimized. With standard surgery, the average local recurrence rate is 29% in all reported controlled trials. With optimal surgery, from institutional series, this figure is about 10%. Other questions to be answered are whether superfractionated or standard fractionation should be used in radiotherapy and exactly to whom it should be given.

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Changing strategy for rectal cancer is associated with improved outcome

Abstract: These data are consistent with the interpretation that the results of treatment can be improved by concentration of surgery to a colorectal team.

Cited by 164 publications

References 17 publications

Cancer Survival in Sweden 1960–1998 Developments Across Four Decades

Cancer Survival in Sweden 1960–1998 Developments Across Four Decades

A Systematic Overview of Radiation Therapy Effects in Rectal Cancer

Perioperative Radiotherapy in the Management of Rectal Cancer

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