Preoperative Radiation with Concurrent 5-Fluorouracil for Locally Advanced T4-Primary Rectal Cancer

Rödel, Claus; Grabenbauer, Gerhard G.; Schick, Christoph; Papadopoulos, Thomas; Hohenberger, Werner; Sauer, Rolf

doi:10.1007/s000660050051

Cited by 65 publications

(45 citation statements)

References 20 publications

(20 reference statements)

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“…In patients with locally advanced, primarily irresectable cancer (i.e. a cancer where a complete gross surgical clearance is deemed unlikely to be achieved), preoperative CRT has been used to cause tumour regression to such an extent that the cancer can be removed radically with adequate clearance in the resection margin (Videtic et al, 1998;Chan et al, 2000;Rodel et al, 2000).…”

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confidence: 99%

Neoadjuvant systemic fluorouracil and mitomycin C prior to synchronous chemoradiation is an effective strategy in locally advanced rectal cancer

et al. 2003

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This study was designed to evaluate the benefits of neoadjuvant chemotherapy prior to chemoradiation and surgery in patients with locally advanced rectal cancer. Patients with previously untreated primary rectal cancer, reviewed in a multidisciplinary meeting and considered to have locally advanced disease on the basis of physical examination and imaging (MRI+CT n ¼ 30, CT alone n ¼ 6), were recruited. Patients received protracted venous infusion 5-FU (300 mg m À2 day À1 for 12 weeks) with mitomycin C (MMC) (7 mg m À2 i.v. bolus every 6 weeks). Starting on week 13, 5-FU was reduced to 200 mg m À2 day À1 and concomitant pelvic radiotherapy 45 Gy in 25 fractions was commenced followed by 5.4 -9 Gy boost to tumour bed. Surgery was planned 6 weeks after chemoradiation. Postoperatively, patients received 12 weeks of MMC and 5-FU at the same preoperative doses. Between January 99 and August 01, 36 eligible patients were recruited. Median age was 63 years (range ¼ 40 -85). Following neoadjuvant chemotherapy, radiological tumour response was 27.8% (one CR and nine PRs) and no patient had progressive disease. In addition, 65% of patients had a symptomatic response including improvement in diarrhoea/constipation (59%), reduced rectal bleeding (60%) and diminished pelvic pain/tenesmus (78%). Following chemoradiation, tumour regression occurred in 80.6% (six CRs and 23 PRs; 95% CI ¼ 64 -91.8%) and only one patient still had an inoperable tumour. R0 resection was achieved in 28 patients (82%). When compared with initial clinical staging, the pathological downstaging rate in T and/or N stage was 73.5% and pathological CR was found in one patient. Neoadjuvant systemic chemotherapy as a prelude to synchronous chemoradiation can be administered with negligible risk of disease progression and produces considerable symptomatic response with associated tumour regression.

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Neoadjuvant systemic fluorouracil and mitomycin C prior to synchronous chemoradiation is an effective strategy in locally advanced rectal cancer

et al. 2003

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“…In addition, it was suggested that extracolonic invasion is not necessarily a poor prognostic factor (11). Rödel et al (12) reported that curative operations may be performed on 94% of patients with contiguous or adherent-to-adjacent pelvic organs, following CRT with 5-fluorouracil regimen. A resection of the pelvic tumor with negative margins was achieved in 84% of patients.…”

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Successful treatment of rectal cancer with perineal invasion: Three case reports

Kitahara

Uemura

Haraguchi

et al. 2014

Molecular and Clinical Oncology

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Abstract. Rectal cancer occasionally invades adjacent organs. However, rectal cancer with perineal invasion is uncommon and difficult to treat. Locally advanced colorectal cancer may be clinically treated with neoadjuvant therapy, followed by en bloc resection. Skin invasion may lead to tumor dissemination via cutaneous blood flow and lymphatic routes. There is currently no firm evidence regarding the treatment of these significantly advanced rectal cancers. In this study, we report 3 cases of rectal cancer with perineal invasion, successfully managed by multimodality treatment. Case 1 is a 52-year-old man with rectal cancer that had invaded the perineum; case 2 is a 38-year-old man with rectal cancer infiltrating the perineal skin and liver metastasis; and case 3 is a 50-year-old woman with rectal cancer and perineal invasion. All the cases were treated with radical excision. No severe complications were observed in the perioperative period. Case 2, in particular, was confirmed to remain alive 5 years after the surgery. Our experience suggests that multimodality treatment, including extended radical surgery, may be a feasible approach to the treatment of rectal cancer with perineal skin invasion.

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“…In the locally advanced tumors (T3, T4 or N+) the surgery is combined with preoperative radiotherapy (RT), which leads to better local control of the disease and to improved survival compared with surgery alone (1,2). Randomized trials have demonstrated, that the outcomes of concomitant chemoradiotherapy (CHT/RT) are superior to the radiotherapy alone (3). The EORTC phase III trial compared radiotherapy alone with radiotherapy combined with chemotherapy (CHT) consisting of administration of 5-fluorouracil and leucovorine (FUFA) as a bolus in weeks 1 and 5.…”

Section: Introductionmentioning

confidence: 99%

Neoadjuvant chemoradiotherapy with capecitabine followed by laparoscopic resection in locally advanced tumors of middle and low rectum – Toxicity and complications of the treatment

Soumarová¹,

Škrovina²,

Bartoš³

et al. 2010

European Journal of Surgical Oncology (EJSO)

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Please cite this article as: Soumarova R, Skrovina M, Bartos J, Gruna J, Wendrinski A, Czudek S, Kycina R, Parvez J. Neoadjuvant chemoradiotherapy with capecitabine followed by laparoscopic resection in locally advanced tumors of middle and low rectum-toxicity and complications of the treatment, European Journal of Surgical Oncology (2009Oncology ( ), doi: 10.1016Oncology ( /j.ejso.2009 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. The aim of this prospective study is to elucidate feasibility of protocol of neodjuvant concomitant radio chemotherapy with capecitabine and long course radiotherapy with subsequent laparoscopic rectal resection. We assessed treatment toxicity, downstaging rate, pathological response to the neoadjuvant treatment, surgery complications, rate of conversions and sphincter-preserving surgical procedures, and intraoperative and early postoperative complications too. Methods:We acquired data of 78 patients from 1 January 2005 to 31 December 2007 with a locally advanced rectal cancer in our study. All patients were indicated for the neoadjuvant concomitant chemoradiotherapy due to locally advanced tumor (T3 or T4) or lymph nodes involvement suspicion (N+). Both radiotherapy (to pelvic region) and chemotherapy (capecitabine) were administered. Rectal tumors were localized within 12cm from the anocutaneous verge. The average follow-up time was 23.9 months. Results:All patients completed their treatment according to the planned regimen and dose. The surgery was performed laparoscopicaly within 4-8 weeks following the concomitant chemoradiotherapy -in 17% cases was converted into conventional surgery. Downstaging was achieved in 69% of patients, pathological complete response in 10 %, histologically negative lymph nodes were documented in 58% of patients. Grade 3 toxicity of the concomitant chemoradiotherapy was present in 3%; grade 2 in 29% of patients, particularly skin and gastrointestinal form. Intraoperative and early postoperative complications of the surgery were 18%. Reoperation was needed in 5% cases. M A N U S C R I P T A C C E P T E D ARTICLE IN PRESS Conclusions:We demonstrated safety and low toxicity of the concomitant chemoradiotherapy with capecitabine.

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Preoperative Radiation with Concurrent 5-Fluorouracil for Locally Advanced T4-Primary Rectal Cancer

Cited by 65 publications

References 20 publications

Neoadjuvant systemic fluorouracil and mitomycin C prior to synchronous chemoradiation is an effective strategy in locally advanced rectal cancer

Neoadjuvant systemic fluorouracil and mitomycin C prior to synchronous chemoradiation is an effective strategy in locally advanced rectal cancer

Successful treatment of rectal cancer with perineal invasion: Three case reports

Neoadjuvant chemoradiotherapy with capecitabine followed by laparoscopic resection in locally advanced tumors of middle and low rectum – Toxicity and complications of the treatment

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