Combined Modality Treatment of Early Rectal Cancer — the UK Experience

Myint, Arthur Sun; Grieve, Robert; McDonald, Alec; Levine, Edward A.; Ramani, Sasirekha; Perkins, Kate; Wong, Helen; Makin, C. A.; Hershman, M. J.

doi:10.1016/j.clon.2007.07.017

Cited by 46 publications

(25 citation statements)

References 28 publications

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“…– The experience of Papillon style contact RT on selected early cancer is published [34]. The International Contact Radiotherapy Evaluation (ICONE) group has launched the CONTEM trial (Observational Study on Contact X-Ray and Transanal Endoscopic Microsurgery) for selected T1–3 tumours using combinations of transanal excision, contact RT and concomitant CT [35].…”

Section: Summary and Direction For Future Trialsmentioning

confidence: 99%

Advances in Radiotherapy in Operable Rectal Cancer

2009

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Aims: Radiotherapy (RT) reduces local recurrence in rectal cancer but the optimal treatment schedule is unknown. Relevant questions in designing optimal therapy are set out. This review identifies evidence that influences current practice and shapes future trials in treatment of operable rectal cancer. Methods: PubMed and MEDLINE search. Results: RT reduces local recurrence and pre-operative treatment is superior to post-operative treatment. Longer interval to surgery and concurrent chemotherapy are associated with greater downstaging, although influence on sphincter preservation and survival is minimal. Short-course RT (SCRT) demonstrates lower recurrence, but with long-term dysfunction and minimal survival benefit. The role of SCRT should be re-evaluated to encompass new criteria/areas. Conclusion: SCRT should be used selectively rather than as a blanket treatment policy. SCRT compounds functional morbidity caused by mesorectal excision which may be excessive in some patient groups, especially early-stage rectal cancer or frail elderly patients. RT and local excision may be a feasible surgical alternative in these groups. Alternatively, SCRT and delayed surgery may be a future alternative to current long-course chemoradiotherapy. As survival is only marginally affected despite low local recurrence, future trials should aim to address metastatic disease. End points which incorporate function and quality of life must be used.

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Section: Summary and Direction For Future Trialsmentioning

confidence: 99%

Advances in Radiotherapy in Operable Rectal Cancer

2009

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“…A number of publications by French, American and British groups have demonstrated the feasibility of using contact X-ray treatment either on its own or in combination with external beam radiotherapy for definitive treatment of rectal cancer [16,[53][54][55][56]. However, published studies are almost exclusively retrospective, singleinstitution series, with wide mix of patients and radiation doses, as well as many series using local excision for nearcomplete responders.…”

Section: Contact X-ray Therapy (Papillon Treatment)mentioning

confidence: 95%

Radiation Techniques for Increasing Local Control in the Non-Surgical Management of Rectal Cancer

Appelt

Jakobsen

2015

Curr Colorectal Cancer Rep

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A fraction of patients with rectal cancer can achieve clinical complete response following longcourse chemoradiotherapy (CRT), and there is accumulating clinical evidence that these patients can be managed non-surgically with acceptable oncological outcome. Consequently, strategies for increasing the proportion of complete responders are actively being explored. Some, although limited, experience with high-dose radiotherapy indicates that there might exist a dose-response relationship for local tumour control after radiotherapy alone. Thus, tumour dose escalation could be indicated for selected patients, particularly in cases with small tumours and limited local disease. This report discusses several radiotherapy techniques for tumour boosting, focusing on technical challenges and clinical experiences with each technique. Specifically, external beam radiotherapy, brachytherapy and contact X-ray treatment for dose escalation are considered. Ultimately, no technique provides definitive advantage over others, and the choice in clinical practice will have to depend on the patient population treated as well as the technical capabilities of the treating department.

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“…Tumors considered suitable for treatment with contact brachytherapy are T1 polypoid tumors smaller than 3 cm or T2 tumors with evidence of superfi cial ulceration or tethering but, again, not exceeding 3 cm [19]. In the United Kingdom, suitability for local treatment depends on a combination of clinical, radiologic, and histologic criteria; patients considered candidates for this treatment have mobile, exophytic, histologically well-differentiated tumors less than 10 cm from the anal verge, smaller than 3 cm, occupying less than a third of the rectum, and with no radiologic evidence on MRI or endoscopic ultrasound [20]. These criteria defi ne a group of patients with a low risk for nodal and distant metastases.…”

Section: Contact (Papillon-style) Brachytherapymentioning

confidence: 99%