Dose–time fractionation schedules of preoperative radiotherapy and timing to surgery for rectal cancer

Jin, Fang; Luo, Hong; Zhou, Juan; Wu, Yongzhong; Sun, Hao; Liu, Hongliang; Zheng, Xiaodong; Wang, Ying

doi:10.1177/1758835920907537

Cited by 11 publications

(9 citation statements)

References 181 publications

(283 reference statements)

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“…Response to the conventional NART, followed by surgery weeks later, varied between patients. Complete resection rate, pathological complete response rate, 5-year local control rate, and overall survival rate have been reported to be 90-95%, 10-20%, >90%, and 60-85%, respectively [27,28]. In addition, the incidence of perioperative complications and a grade 3 late toxicity rate of approximately 10% were also consistent with those described in previous reports [5,6,29].…”

Section: Discussionsupporting

confidence: 88%

Neoadjuvant Modified Short-Course Radiotherapy Followed by Delayed Surgery for Locally Advanced Rectal Cancer

Doi

Yokoyama

Beppu

et al. 2021

Cancers

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This study aimed to assess the clinical outcomes and predictive factors of neoadjuvant modified short-course radiotherapy (mSC-RT) for locally advanced rectal cancer (LARC). Data from 97 patients undergoing mSC-RT followed by radical surgery for LARC were retrospectively analyzed. A 2.5 Gy dose twice daily up to a total dose of 25 Gy in 10 fractions was administered through mSC-RT, and this was delivered with oral chemotherapy in 95 (97.9%) patients. Radical surgery was performed 6 (range, 3–13) weeks after mSC-RT. The median follow-up among surviving patients was 43 (8–86) months. All patients completed neoadjuvant radiotherapy with no acute toxicity grade ≥ 3. Three- and five-year local control rates were 96.3% and 96.3%, respectively. Three- and five-year overall survival (OS) rates were 92.7% and 79.8%, respectively. Univariate analyses revealed that poor OS was associated with no concurrent administration of capecitabine, C-reactive-protein-to-albumin ratio ≥ 0.053, carcinoembryonic antigen ≥ 3.4 ng/mL, and neutrophil-to-lymphocyte ratio (NLR) ≥ 1.83 (P = 0.045, 0.001, 0.041, and 0.001, respectively). Multivariate analyses indicated that NLR ≥ 1.83 was independently associated with poor OS (p = 0.018). mSC-RT followed by delayed surgery for LARC was deemed feasible and resulted in good clinical outcomes, whereas poor OS was associated with high NLR.

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Section: Discussionsupporting

confidence: 88%

Neoadjuvant Modified Short-Course Radiotherapy Followed by Delayed Surgery for Locally Advanced Rectal Cancer

Doi

Yokoyama

Beppu

et al. 2021

Cancers

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“…The purpose is to achieve a certain clinical and pathological downstage effect of the tumor and increase the radical resection rate. Increasing the resection rate will play a certain role in improving the local control rate and survival rate [4,5].…”

Section: Discussionmentioning

confidence: 99%

“…Most clinical studies of preoperative CRT are based on platinum regimens to obtain the radiosensitizing effect. [1][2][3][4][5] This article retrospectively analyzes the efficacy and toxicity of preoperative CRT in patients with locally advanced unresectable rectal cancer.…”

Section: Introductionmentioning

confidence: 99%

Responses of Patients with T3-4N0- 2 M0 Rectal Cancer to Preoperative Chemoradiotherapy: Review of Current Literature

et al. 2022

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Objective: To investigate the efficacy and safety of chemoradiotherapy and radiotherapy followed by surgery in patients with locally advanced unresectable rectal cancer.Material and method: We reviewed records for 65 patients with locally advanced unresectable rectal cancer treated by preoperative chemoradiotherapy or radiotherapy followed by surgery between 2013 and 2016. Of these, 23 patients were treated with preoperative chemoradiotherapy (40 - 45 Gy) plus concomitant chemotherapy (5Fluorouracil + Calcium Folinate). For comparison, 42 similar patients, treated by preoperative radiotherapy (45 - 50Gy) plus surgery served as control. The primary end-point of the study was overall survival and local control rate.Results: No treatment plan was delayed because of toxicities in both groups. The radical resectability rate was 69.9 % in the chemoradiotherapy group and 33.3 % in the radiotherapy plus surgery group (P = 0. 024). The anal sphincter preservation rates were 26. 6 % and 3. 7 %, respectively (P= 0. 028). The anal sphincter preservation rates of the lower rectal cancer were 27. 3 % and 0. 0 %, respectively (P = 0. 014). Response rates of chemoradiotherapy and radiotherapy plus surgery groups were 82.6 % and 61.9 % (P = 0. 053). The tumor downstage rates were 16 (69.6%) and 24 (57.1%) in these groups (P = 0. 206). The 3-years overall survival rates were 66. 7 % and 55. 6 % (P = 0. 485), and the tumor-free survival rates were 40. 3 % and 33. 1 % (P = 0. 663) . The 3-years local recurrent rates were 26. 9 % and 48. 1 % (P = 0. 174) . No obvious late effects were found in either group. Conclusion: The results of this study suggested at least that acute side effects of preoperative chemoradiotherapy can be tolerated and a higher surgical resection rate can be achieved. However, the chemoradiotherapy did not improve the survival rate while it increased local recurrence due to the high rate of anal sphincter preservation. It is safe and effective to use 5-Fluorouracil + Calcium Folinate and 5 – DFUR as a radiosensitizer during the whole course of radiotherapy.

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“…Currently, less than 10% of patients who undergo radical treatment experience LR [17][18][19], owing to the use of an appropriate surgical technique (TME), the radical nature of the procedures (R0, circumferential resection margins: negative), and the combined treatments based on the RT schedule delivering a biologically effective dose above 30 Gy [20,21]. Several studies have shown that about half of LRs are isolated, with no distant metastatic lesions [22,23].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Endoscopic Surveillance in the Detection of Local Recurrence After Radical Rectal Cancer Surgery is Limited: A Retrospective Study.

Jankowski

Wysocki

Tkaczyński

et al. 2021

Preprint

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Background: Rectal cancer, one of most common neoplasms, is characterized by an overall survival rate exceeding 60%. Nonetheless, local recurrence (LR) following surgery for rectal cancer remains a formidable clinical problem. The aim of this study was to assess the value of postoperative endoscopic surveillance (PES) for the early detection of LR in rectal cancer after radical treatment.Methods: We performed an anterior resection in 228 patients with stage I-III rectal cancer who had undergone surgery from 2001 to 2008 in the Oncology Center in Bydgoszcz, Poland. Of these patients, 169 had perioperative radiotherapy or radiochemotherapy. All patients underwent PES with imaging (abdominal ultrasound or computed tomography scan, pelvic magnetic resonance imaging) and endoscopic examinations. The ratios of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and receiver operating characteristic curve were calculated to compare the diagnostic value of colonoscopy versus imaging techniques. Results: During the 5-year follow-up, recurrences occurred in 49 (21%) patients; of these, 15 (6%) had LR, which was most often located outside the intestinal lumen (n = 10, 4%). Anastomotic LR occurred in 5 (2%) patients. The mean time to anastomotic LR was 30 months after initial surgery, similar to that of other locations (29 months). Both imaging and endoscopy were shown to be efficient techniques for the diagnosis of LR in anastomotic sites, and endoscopy did not provide any additional benefit in patients who were receiving radiation therapy.Conclusions: The benefit of PES for the detection of LR after curative treatment of rectal cancer is limited. It remains a useful method, however, for the histopathological confirmation of suspected or confirmed recurrence.

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Dose–time fractionation schedules of preoperative radiotherapy and timing to surgery for rectal cancer

Cited by 11 publications

References 181 publications

Neoadjuvant Modified Short-Course Radiotherapy Followed by Delayed Surgery for Locally Advanced Rectal Cancer

Neoadjuvant Modified Short-Course Radiotherapy Followed by Delayed Surgery for Locally Advanced Rectal Cancer

Responses of Patients with T3-4N0- 2 M0 Rectal Cancer to Preoperative Chemoradiotherapy: Review of Current Literature

Efficacy of Endoscopic Surveillance in the Detection of Local Recurrence After Radical Rectal Cancer Surgery is Limited: A Retrospective Study.

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