Erste Ergebnisse der neoadjuvanten simultanen Radiochemotherapie bei fortgeschrittenen Rektumkarzinomen

Küchenmeister, Ute; Kirchner, R; Mellert, J.; Klautke, Günther; Mücke, Ralph; Hopt, Ulrich-Theodor; Fietkau, Rainer

doi:10.1007/pl00002325

Cited by 8 publications

(8 citation statements)

References 21 publications

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“…A pCR rate of 8 -10% was found in studies with 5-fluorouracil-based regimens, 5% in an earlier study of our group (Küchenmeister et al, 2000) and the substitution of an oral prodrug for intravenous 5-fluorouracil does not appear to improve these results, with a pCR rate of 4 -9% (Table 4) besides one exception by a group from Korea with a pCR rate of 31% (Kim et al, 2002). Compared with these data, the addition of irinotecan to 5-fluorouracil in the present study resulted in a gross doubling of the pCR rate to over 20%.…”

Section: Discussionmentioning

confidence: 47%

“…Several phase II studies of 5-fluorouracil-based preoperative chemoradiotherapy for locally advanced rectal cancer have reported R0 resection rates of 60 -85% (Chan et al, 1993;Minsky et al, 1993;Keilholz et al, 1995;Videtic et al, 1998;Küchenmeister et al, 2000;Rödel et al, 2000) including pathologic complete response (pCR) rates of 5 -20%. Even in low rectal tumours, sphincter-preserving surgery was possible after preoperative chemoradiotherapy in 27 -86% of the patients (Grann et al, 1997;Hyams et al, 1997;Maghfoor et al, 1997;Küchenmeister et al, 2000). Moreover, randomised trials have shown that neoadjuvant chemoradiotherapy improves local control compared with postoperative chemoradiation in primary resectable tumours (Roh et al, 2001;Sauer et al, 2004).…”

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confidence: 99%

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Intensified concurrent chemoradiotherapy with 5-fluorouracil and irinotecan as neoadjuvant treatment in patients with locally advanced rectal cancer

Klautke¹,

Feyerherd

Ludwig

et al. 2005

Br J Cancer

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This study aimed to evaluate the feasibility and efficacy of neoadjuvant chemoradiotherapy intensified with irinotecan in patients with locally advanced rectal cancer. Eligible patients had nonmetastatic disease at a locally advanced stage that made R0 resection and sphincter preservation uncertain. They received preoperative radiation over 6 weeks to 45 Gy and boost of 5.4 Gy and concurrent continuous infusion 5-fluorouracil 250 mg m À2 day À1 and weekly irinotecan 40 mg m À2 . In all, 37 patients entered the study. T stage at baseline as determined by ultrasound was T2/T3/T4 in 2/19/16 patients; 31 patients had lymph node involvement. The predominant toxicity was diarrhoea (grade 3/4 in 10/2 patients). Haematologic toxicity and surgical complications were moderate. Among 36 patients undergoing surgery, 32 (89%) had R0 resection and 23 (64%) sphincter preservation. Pathologic complete response (pCR) was achieved in eight (22%) of 36 patients, and 10 patients (28%) had only microscopic residual disease. At 4 years, overall survival was 66%, disease-free survival 73%, local relapse rate 7%, and distant failure rate 24%. Extent of resection and postoperative nodal status were significant predictors of overall and disease-free survival. Intensified neoadjuvant chemoradiotherapy with irinotecan can be safely administered and results in a high pCR rate.

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Section: Discussionmentioning

confidence: 47%

mentioning

confidence: 99%

Intensified concurrent chemoradiotherapy with 5-fluorouracil and irinotecan as neoadjuvant treatment in patients with locally advanced rectal cancer

Klautke¹,

Feyerherd

Ludwig

et al. 2005

Br J Cancer

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“…Increase of local control and survival has been shown compared with surgery alone in the Swedish Rectal Cancer Study 1997 [31]. It is widely accepted and supported by excellent phase-II study results that further intensification of preoperative radiotherapy such as addition of several schemes of chemotherapy [14,18] or regional hyperthermia [22] is indicated at least in a highrisk group of patients with locally advanced rectal cancer such as T4 category, distal location and fixation (stage according to Mason). However, for resectable rectal cancer the value of preoperative vs postoperative radiochemotherapy is still under evaluation [25,26].…”

Section: Introductionmentioning

confidence: 99%

Restaging of Locally Advanced Carcinoma of the Rectum with MR Imaging after Preoperative Radio-Chemotherapy plus Regional Hyperthermia

Hoffmann¹,

Rau

Wust³

et al. 2002

Strahlentherapie und Onkologie

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MRI proved independent of the response status as not suitable to restage locally advanced rectal carcinoma after preoperative radiochemotherapy despite optimized imaging technique and spatial resolution. Basically, imaging the morphology of a tumor cannot clearly differentiate between vital and devitalized tissue after a treatment. Functional imaging such as PET (positron emission tomography) appears more feasible for restaging after radio-chemo-thermotherapy.

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“…Preoperative chemoradiation increases the resection rate (Reerink et al, 2003) and preoperative radiation or chemoradiotherapy decrease local recurrence and reduce small bowel complications compared with postoperative therapy (Minsky et al, 1992;Frykholm et al, 1993, Sauer et al, 2004. R0 resection rates of 60 -85% have reported with 5-FUbased preoperative chemoradiation for LARC (Videtic et al, 1998;Küchenmeister et al, 2000;Rödel et al, 2000).…”

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confidence: 99%

Concurrent chemoradiation with capecitabine and weekly irinotecan as preoperative treatment for rectal cancer: results from a phase I/II study

et al. 2006

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The aim of this study was to investigate the efficacy and safety of chemoradiation using capecitabine and irinotecan as neoadjuvant therapy for patients with rectal cancer. Conventional radiation was given at daily fractions of 1.8 Gy on 5 days a week for a total dose of 55.8 (50.4 þ 5.4) Gy. Concurrently, irinotecan 40 mg m À2 once weekly and capecitabine continuously at dose levels of 500, 650, 750 and 825 mg m À2 twice daily were administered. Surgery was performed 4 -6 weeks following completion of chemoradiation. A total of 28 patients (3 UICC II, 25 UICC III) were enrolled and all received treatment. Dose-limiting toxicity was diarrhoea grade IV and hand -foot syndrome at the 825 mg m À2 dose level. The maximum tolerated dose of capecitabine was 750 mg m À2 . Diarrhoea was the most common toxicity: grade III in nine patients. Two patients died, one due to pneumonia and one due to sudden cardiac death. A complete response and only microfocal residual tumour disease was achieved in four and three patients (27%). In all, 25 of 28 patients undergoing surgery, 24 (96%) had R0 resection. Preoperative chemoradiation based on continuous daily capecitabine and weekly irinotecan appears to tolerated and effective in patients with rectal cancer.

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Erste Ergebnisse der neoadjuvanten simultanen Radiochemotherapie bei fortgeschrittenen Rektumkarzinomen

Abstract: Preoperative radiochemotherapy followed by surgery is able to achieve clear resection margins in more than 70% of patients with locally advanced rectal cancer and may improve the rate of sphincter-conserving surgery.

Cited by 8 publications

References 21 publications

Intensified concurrent chemoradiotherapy with 5-fluorouracil and irinotecan as neoadjuvant treatment in patients with locally advanced rectal cancer

Intensified concurrent chemoradiotherapy with 5-fluorouracil and irinotecan as neoadjuvant treatment in patients with locally advanced rectal cancer

Restaging of Locally Advanced Carcinoma of the Rectum with MR Imaging after Preoperative Radio-Chemotherapy plus Regional Hyperthermia

Concurrent chemoradiation with capecitabine and weekly irinotecan as preoperative treatment for rectal cancer: results from a phase I/II study

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