Preoperative irradiation for cancer of the rectum and rectosigmoid

Stearns, Maus W.; Deddish, Michael R.; Quan, Stuart H. Q.

doi:10.1007/bf02617155

Cited by 45 publications

(18 citation statements)

References 2 publications

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“…The dose increment between trial 89-02 and trial 91-9 1 was in accordance to the dose response data obtained by an extensive review of the literature (15,20,21,32,35,37,40,42). Low-dose radiotherapy has no significant effect on local control (20,32,37,40), whereas doses higher than 20 Gy seem to significantly affect local recurrence rate (15,42). It is interesting to note that both in the Stockholm Trial and in the EORTC 40761 trial there is a positive impact of radiation on pelvic control.…”

Section: Discussionsupporting

confidence: 86%

The rationale to switch from postoperative hyperfractionated accelerated radiotherapy to preoperative hyperfractionated accelerated radiotherapy in rectal cancer

Coucke

Sartorelli

Cuttat

et al. 1995

International Journal of Radiation Oncology*Biology*Physics

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Purpose: To demonstrate the feasibility of preoperative Hyperfractionated Accelerated RadioTherapy (preop-HART) in rectal cancer and to explain the rationales to switch from postoperative HART to preoperative HART. Methods and 1989. In trial Materials: Fifty-two consecutive patients were introduced in successive Phase I trials since 89-01. m&operative HART (48 Gv in 3 weeks) was applied in 20 patients. In nine patients with locally advanced rectal cancer, considered unresectable by the surgeon, 32 Gy in 2 weeks was-applied prior to surgery (trial 89-02). Since 1991, 41.6 Gy in 2.5 weeks has been applied preoperatively to 23 patients with T3-T4 any N rectal cancer immediately followed by surgery (trial 91-01). All patients were irradiated at the department of radiation-oncology with a four-field box technique (1.6 Gy twice a day and with at least a 6-h interval between fractions). The minimal accelerating potential was 6 MV. Acute toxicity was scored according to the World Health Organization (WHO for skin and small bowel) and the Radiation Therapy Oncology Group criteria (RTOG for bladder). This was done weekly during treatment and every 3 months thereafter. Small bowel volume was estimated by a modiiied "Gallagher's" method. Results: Acute toxicity was acceptable both in postoperative and preoperative setup. The mean acute toxicity ~significantly lower in trial 91-01 compared to 89-01. This difference was due to the smaller amount of small bowel in irradiation field and lower total dose in trial 91-01. Moreover, there was a significantly reduced delay between surgery and radiotherapy favoring trial 91-01 (median delay 4 days compared to 46 days in trial 89-01). Nearly all patients in trial 89-02 and 91-01 underwent surgery (31 out of 32; 97%). Resection margins were negative in 29 out of 32. Hospitalization duration in trial 91-01 was not significantly different from trial 89-01 (19 vs. 21 days, respectively). Conclusions: Hyperfractionated accelerated radiotherapy immediately followed by surgery is feasible as far as acute toxicity is concerned. Preoperative HART is favored by a significantly lower acute toxicity related, in part, to a smaller amount of irradiated small bowel, and a shorter duration of the delay between radiotherapy and surgery. Moreover, the hospital stay after preoperative HART is not significantly increased.Hyperfractionation, Acceleration, Preoperative radiotherapy, Rectal cancer.

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Section: Discussionsupporting

confidence: 86%

The rationale to switch from postoperative hyperfractionated accelerated radiotherapy to preoperative hyperfractionated accelerated radiotherapy in rectal cancer

Coucke

Sartorelli

Cuttat

et al. 1995

International Journal of Radiation Oncology*Biology*Physics

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“…Among the 196 studies reviewed, 14 RCTs met the inclusion criteria. [5][6][7][8][9][10][11][12][13][14][15][16][17][18] Studies were excluded if they combined preoperative and postoperative radiotherapy 23 ; if they did not have a surgery alone group as control 20,21 ; if they were nonrandomized [27][28][29][30] or if they enrolled randomized and nonrandomized patients 25,26 ; if they stopped after accruing only a few patients 31 ; or, if published as a preliminary report, 19,22,24,[32][33][34] a final article was published subsequently. Since all the trials reported as abstracts [36][37][38] were subsequently published as full articles, this meta-analysis included only peerreviewed reports.…”

Section: Selection Of Randomized Trialsmentioning

confidence: 99%

Preoperative Radiotherapy for Resectable Rectal Cancer

Cammà¹,

Giunta²,

Fiorica³

et al. 2000

JAMA

703

361

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“…43 Because patients with local-regional recurrences are rarely salvaged and difficult to palliate, a considerable interest developed in using adjuvant RT to reduce the likelihood of this event. 28,43,[72][73][74][75][76]78 After a number of nonrandomized single-institution trials showed that moderate-dose RT given before or after surgery markedly reduced the localregional recurrence rate and potentially improved survival, prospective randomized trials were undertaken to evaluate the question.…”

Section: Results Of Treatment For Locally Advanced Resectable Rectalmentioning

confidence: 99%

Radiotherapy in the Treatment of Resectable Rectal Adenocarcinoma

Mendenhall¹,

Zlotecki²,

Snead³

et al. 2009

American Journal of Clinical Oncology

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The goal of treatment is to cure whereas maintaining sphincter function and minimizing toxicity. Although the mainstay of the treatment is surgery, radiotherapy (RT) is used in a substantial proportion of patients depending on the location and extent of the tumor. The aim of this article is to discuss the role of RT in patients with resectable rectal adenocarcinoma. This article is a review of the pertinent literature. Results show that patients with T1N0 exophytic, well to moderately differentiated, mobile tumors < or = 3 cm in diameter may be treated with either transanal excision or endocavitary RT. The probability of cure with either approach is approximately 80% to 90% and depends on selection criteria. The advantages of endocavitary RT are that it is an outpatient procedure requiring, at most, local anesthesia and is suitable for elderly, infirm patients. The disadvantage is that few of these treatment units are available. Patients who experience a local-regional recurrence may be surgically salvaged. Patients who undergo transanal excision and have unfavorable pathologic findings including equivocal or close margins, poor differentiation, invasion of the muscularis propria, and/or endothelial-lined space invasion have a high risk of local-regional recurrence after surgery alone. The addition of postoperative RT improves the likelihood of cure from 85% to 90%. Patients presenting with unfavorable tumors that are borderline resectable with a transanal excision may be downstaged with preoperative RT and rendered suitable for a wide local excision. The addition of concomitant chemotherapy probably enhances downstaging and may improve the likelihood of sphincter preservation. Patients with T3 and/or N1 rectal cancers have a relatively high probability of local-regional recurrence after surgery alone. Preoperative RT and postoperative RT combined with adjuvant chemotherapy have been shown to significantly reduce the risk of local-regional recurrence and improve survival. Whether preoperative RT alone or combined with chemotherapy is more efficacious than postoperative chemoradiation remains unclear. Endocavitary RT or transanal excision is suitable for patients with T1N0 cancers. Depending on tumor location and extent, adjuvant RT may improve the probability of local-regional control and survival for patients with locally advanced rectal adenocarcinomas.

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Preoperative irradiation for cancer of the rectum and rectosigmoid

Cited by 45 publications

References 2 publications

The rationale to switch from postoperative hyperfractionated accelerated radiotherapy to preoperative hyperfractionated accelerated radiotherapy in rectal cancer

The rationale to switch from postoperative hyperfractionated accelerated radiotherapy to preoperative hyperfractionated accelerated radiotherapy in rectal cancer

Preoperative Radiotherapy for Resectable Rectal Cancer

Radiotherapy in the Treatment of Resectable Rectal Adenocarcinoma

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