Extensive surgery after high-dose preoperative chemoradiotherapy for locally advanced recurrent rectal cancer

Abstract

A combination of high-dose preoperative chemoradiotherapy followed by extended surgery can achieve clear resection margins in more than 60 percent of patients with recurrent rectal tumor not amenable to primary surgery. An encouraging trend evolved for this multimodal treatment to improve long-term local control and survival rate.

CPT-11 and concomitant hyperfractionated accelerated radiotherapy induce efficient local control in rectal cancer patients: results from a phase II

“…It has been reported that 20 -35% of the patients develop diarrhoea Xgrade 2 when treated with a conventional radiotherapy technique using large irradiation fields (Minsky et al, 1995;Bosset et al, 2004). The overall incidence of postoperative complications is 27% and is in the range of what has been observed with 5FU-based protocols (Swedish Rectal Cancer Trial, 1997;Rodel et al, 2000;Ngan et al, 2001;Marijnen et al, 2002;Mehta et al, 2003;Bosset et al, 2004). Recently, the large randomised German trial on chemoradiotherapy reported a 36% postoperative complication rate (Table 5) (Sauer et al, 2004).…”

“…Our trial suggests that the incidence of severe diarrhoea (24%) is comparable to that in standard 5FU regimens, the latter being associated with diarrhoea in up to 23% of the patients (Table 5) Minsky '99 (Minsky et al, 1999) CPT-11 18 --Mehta '03 (Mehta et al, 2003) CPT-11, 5-FU 28 38 # 6 Mitchell '03 (Mitchell et al, 2003) CPT-11, 5-FU 27 --Dotor '04 (Dotor et al, 2004) CPT-11, 5-FU 14 --Levine '04 (Levine et al, 2004) CPT-11, 5-FU 3 --Hofheinz '05 (Hofheinz et al, 2005) CPT-11, CAP 50 -75* 47 7 Klautke '05 (Klautke et al, 2005) CPT-11, 5-FU 32 14 9 Voelter '06 CPT-11 24 27 6 Minsky '93 (Minsky et al, 1993) 5-FU 17 45 18 Rö del '00 (Rodel et al, 2000) 5-FU 23 28 18 Sauer '04 (Sauer et al, 2004) 5-FU 12 36 11 Bosset '04 (Bosset et al, 2004) +/5-FU s 17/34** 22/23 -Marijnen '02 + 14** 48 11 SRCT '97 (Swedish Rectal Cancer Trial, 1997) + -4 4 1 1 1993; Rodel et al, 2000;Bosset et al, 2004;Sauer et al, 2004). Other trials investigating CPT-11 have shown similar results to ours (Minsky et al, 1999;Mehta et al, 2003;Mitchell et al, 2003;Dotor et al, 2004;Levine et al, 2004;Hofheinz et al, 2005;Klautke et al, 2005).…”

“…Recently, the large randomised German trial on chemoradiotherapy reported a 36% postoperative complication rate (Table 5) (Sauer et al, 2004). The rate of anastomotic leakage (AL) after low anterior resection and TME is usually in the range of 6 -18% depending on the series and whether protective ileostomy has been applied or not (Swedish Rectal Cancer Trial, 1997;Rodel et al, 2000;Marijnen et al, 2002;Mehta et al, 2003;Sauer et al, 2004). The AL rate of 6% in our trial compares favourably and indicates that the administration of neoadjuvant CPT-11 with radiotherapy is safe.…”

Recidiva pélvica de adenocarcinoma de reto: abordagem cirúrgica

“…A ressecção cirúrgica do segmento acometido com adenocarcinoma retal aliada à excisão total do mesorreto (ETM), além da neoadjuvância, tem sido preconizada para o tratamento desta afecção, com redução das taxas de recidiva local. (1,2,3,4,5,6) No entanto, a recidiva pélvica após ressecção curativa do câncer retal, continua influenciando na sobrevida dos doentes, e constituindo importante causa de morbidade pós-operatória. Entre 3% a 35% dos doentes evoluirão com recidiva local.…”

“…Entre 3% a 35% dos doentes evoluirão com recidiva local. (3,5,6,7,8) Os fatores que estão implicados nas diferentes taxas de recidiva observadas na literatura, são aqueles relacionados à técnica operatória e à própria biologia do tumor. O estadiamento inicial da neoplasia é um dos fatores relacionados à biologia tumoral, sendo considerado o mais importante.…”