In search of a dose-response relationship with radiotherapy in the management of recurrent rectal carcinoma in the pelvis: A systematic review

Wong, Rebecca; Thomas, Gillian; Froud, P; Shelley, Wendy; Withers, Rodney; Williams, Jack I.

doi:10.1016/s0360-3016(97)00711-6

Cited by 35 publications

(12 citation statements)

References 27 publications

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“…The 5-year survival rates vary between 0 and 81% for patients treated with a curative approach [10,11,12,13]. Radiotherapy, either alone or in combination with chemotherapy, allows symptomatic improvement in most patients, but the 5-year survival is usually less than 5% [14]. …”

Section: Introductionmentioning

confidence: 99%

Doubling Time of Carcinoembryonic Antigen Is a Significant Prognostic Factor after the Surgical Resection of Locally Recurrent Rectal Cancer

Noura¹,

Ohue²,

Seki³

et al. 2008

Dig Surg

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Background: Patients undergoing a curative rectal cancer resection have a risk of developing locoregional recurrence. A curative resection for local recurrence is the option of improvement in prognosis. However, a curative resection is sometimes too invasive and should be considered in selected patients. Methods: A total of 43 patients with locally recurrent rectal cancer who had been treated by operation between 1989 and 2007 were retrospectively reviewed and the factors, including doubling time of carcinoembryonic antigen (CEA-dt), were analyzed. Results: The 5-year overall survival rate after the operation for local recurrence was 50.8%. Gender, presence of distant metastasis, tumor size, CEA-dt and curability were found to be significant prognostic factors. A multivariate analysis demonstrated the presence of distant metastasis, CEA-dt and tumor size to be significant prognostic factors for overall survival. The 5-year overall survival rates of patients with a CEA-dt ≧150 days and a tumor size <5 cm were 76.9%. Conclusions: The tumor size and CEA-dt were useful prognostic factors that were recognizable before surgery. Patients with locally recurrent rectal cancer with a CEA-dt ≧150 days and a recurrent tumor size <5 cm are considered to be good candidates for surgery.

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Section: Introductionmentioning

confidence: 99%

Doubling Time of Carcinoembryonic Antigen Is a Significant Prognostic Factor after the Surgical Resection of Locally Recurrent Rectal Cancer

Noura¹,

Ohue²,

Seki³

et al. 2008

Dig Surg

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“…External-beam radiation can offer some palliation, but curative local control is rare (5 percent). 18,[22][23][24][25][26] Use of high-dose external radiation is associated with a high risk of radiation damage to normal contiguous structures. Because the dose penetration and therefore adjacent organ exposure is less with IORT combined with preoperative externalbeam irradiation plus concomitant chemotherapy, followed by surgical resection, IORT treatment should be a safer and more effective alternative to high-dose external-beam radiation.…”

Section: Discussionmentioning

confidence: 99%

Use of High-Dose-Rate Brachytherapy in the Management of Locally Recurrent Rectal Cancer

Kuehne

Kleisli²,

Biernacki³

et al. 2003

Diseases of the Colon &Amp; Rectum

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“…For example, Wong et al [45] could not derive a dose-effect relationship for the management of recurrent rectal carcinoma in the pelvis. This could be explained by the fact that the groups of patients were not homogeneous enough to observe such relations.…”

Section: Discussionmentioning

confidence: 99%

What accuracy is required and can be achieved in radiation therapy (review of radiobiological and clinical data)

Wambersie¹

2001

Radiochimica Acta

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Radiation therapy / Accuracy / Quality assurance / Tumour control / Complications / OptimisationSummary. An attempt is made to formulate the requirements for the accuracy in the delivery of absorbed dose to a patient during radiation therapy. These requirements are mainly based on the relative steepness and separation of the dose-effect curves for local tumour control and normal tissue damage. The curves for normal tissue complications in general may be steeper than those for local tumour control. From these data, a standard requirement of 3.5% is proposed for the combined uncertainty of type A (random) and type B (systematic), given as one relative standard deviation in the absorbed dose delivery. However, it is recognized that, in many cases, larger uncertainties are acceptable (palliative treatments). This value of 3.5% applies to the absorbed dose at the specification point for curative treatments. As far as the dose accuracy requirements at other points in the planning target volume are concerned, a value of 5% (one standard deviation) seems more appropriate. This required accuracy in the delivery of the absorbed dose cannot always be completely achieved in photon therapy even for simple treatment conditions. All the clinical data which were reviewed, including some results from the "Patterns of Care Study", indicate a close correlation between the outcomes of therapy (control rates, complications) and dose level, inaccuracy or errors in dosimetry and patient-machine positioning. This has been reported for external beam therapy as well as for brachytherapy. Only the clinical results will allow us to select the optimal treatment conditions (e.g. selection and definition of the planning target volumes, dose levels and beam arrangement), but they could be interpreted correctly only to the extent that the treatment execution would be correct. This result strongly endorses the Quality Assurance Programmes, in which the clinicians and physicists should be fully involved. Lastly, the outcome of a treatment can only be interpreted meaningfully if the parameters of the irradiation, in particular, the distribution of dose in space and time can be accurately correlated with the type and extent of the disease. It is essential that clear, well defined and unambiguous concepts and parameters be used for reporting purposes to ensure a common language between collaborating centres. This is one of the major tasks that the ICRU undertook several years ago.

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In search of a dose-response relationship with radiotherapy in the management of recurrent rectal carcinoma in the pelvis: A systematic review

Cited by 35 publications

References 27 publications

Doubling Time of Carcinoembryonic Antigen Is a Significant Prognostic Factor after the Surgical Resection of Locally Recurrent Rectal Cancer

Doubling Time of Carcinoembryonic Antigen Is a Significant Prognostic Factor after the Surgical Resection of Locally Recurrent Rectal Cancer

Use of High-Dose-Rate Brachytherapy in the Management of Locally Recurrent Rectal Cancer

What accuracy is required and can be achieved in radiation therapy (review of radiobiological and clinical data)

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