Preoperative Radiotherapy and Radical Surgery as Combined Treatment in Rectal Cancer

Gérard, A; Berrod, Jean-Louis; Pene, F.; Loygue, J; Laugier, A; Bruckner, Roland; Camelot, G; Arnaud, Jean‐Pierre; Metzger, U; Buyse, Marc

doi:10.1007/978-3-642-83293-2_19

Cited by 14 publications

(4 citation statements)

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“…Before the widespread diffusion of the technique of mesorectal excision, many studies, including 4 randomized studies, had compared pre-operative radiotherapy (RT) versus surgery alone [6-9]. Results showed only a benefit in terms of local control with a reduction of 10% to 5% of the recurrence rate local for patients with optimal dissection of the mesorectum, but no survival benefit.…”

Section: Introductionmentioning

confidence: 99%

A multicentric randomized controlled trial on the impact of lengthening the interval between neoadjuvant radiochemotherapy and surgery on complete pathological response in rectal cancer (GRECCAR-6 trial): rationale and design

et al. 2013

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BackgroundNeoadjuvant radiochemotherapy (RCT) is now part of the armamentarium of cancer of the lower and middle rectum. It is recommended in current clinical practice prior to surgical excision if the lesion is classified T3/T4 or N+. Histological complete response, defined by the absence of persistent tumor cell invasion and lymph node (ypT0N0) after pathological examination of surgical specimen has been shown to be an independent prognostic factor of overall survival and disease-free survival. Surgical excision is usually performed between 6 and 8 weeks after completion of CRT and pathological complete response rate ranges around 12%. In retrospective studies, a lengthening of the interval after RCT beyond 10 weeks was found as an independent factor increasing the rate of pathological complete response (between 26% and 31%), with a longer disease-free survival and without increasing the operative morbidity. The aim of the present study is to evaluate in 264 patients the rate of pathological complete response rate of rectal cancer after RCT by lengthening the time between RCT and surgery.Methods/designThe current study is a multicenter randomized trial in two parallel groups comparing 7 and 11 weeks of delay between the end of RCT and cancer surgery of rectal tumors.At the end of the RCT, surgery is planified and randomization is performed after patient’s written consent for participation. The histological complete response (ypT0N0) will be determined with analysis of the complete residual tumor and double reading by two pathologists blinded of the group of inclusion. Patients will be followed in clinics for 5 years after surgery. Participation in this trial does not change patient’s management in terms of treatment, investigations or visits. Secondary endpoints will include overall and disease free survival, rate of sphincter conservation and quality of mesorectal excision. The number of patients needed is 264.Trial registrationClinicalTrial.gov: NCT01648894

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Section: Introductionmentioning

confidence: 99%

A multicentric randomized controlled trial on the impact of lengthening the interval between neoadjuvant radiochemotherapy and surgery on complete pathological response in rectal cancer (GRECCAR-6 trial): rationale and design

et al. 2013

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“…Rectal cancers form one third to one half of all colorectal cancers and are a major health burden. Traditionally, a wide variation in local recurrence rates from 3% to 32% following surgery alone has been recorded [1] with the presence of tumour within 1 mm of the surgical circumferential resection margin (CRM) being a strong prognostic indicator for increased local recurrence, distant metastases and poor survival [2–5]. Local recurrence can be reduced with improvement in surgical technique through the adoption of the procedure of total mesorectal excision (TME) [6,7].…”

Section: Introductionmentioning

confidence: 99%

Magnetic resonance imaging in rectal cancer downstaged using neoadjuvant chemoradiation: accuracy of prediction of tumour stage and circumferential resection margin status

Kulkarni¹,

Gollins²,

Maw³

et al. 2008

Colorectal Disease

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Magnetic resonance imaging has good specificity and negative predictive value for predicting an uninvolved CRM post downstaging CRT in locally advanced rectal cancer although sensitivity and positive predictive value for an involved CRM were unsatisfactory. The shortcomings of MRI stem from poor differentiation of viable tumour from posttreatment changes and inability to identify small nodal and tumour deposits. Clinical correlates in this group of patients have confirmed the importance of achieving a clear CRM at surgery.

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“…Recent papers suggest that these high-risk patients may in fact benefit from adjuvant therapy [13,31,34], It appears that combined radioand chemotherapy is more effective than radiotherapy alone in these patients [4,29], These preliminary results need to be con firmed by prospective studies in which there is a control group treated by surgery alone with a recurrence rate of 15% for all patients and not more than 30% for high risk patients. Addi tionally, these studies should strictly observe the data collect ing principles and requirements as recommended by [3,20].…”

Section: Adjuvant and Neoadjuvant Therapymentioning

confidence: 99%

Decision-making in Curative Rectum Carcinoma Surgery

Hohenberger¹,

Hermanek²,

Gall³

1992

Oncol Res Treat

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Rectal carcinomas are increasingly treated by more and more differentiated regimens. Until the 1970s, the rectal excision was standard, whereas in 58% sphincter-saving procedures were performed during the last years. Locoregional recurrences are the main problem of surgical treatment for rectum carcinomas. They are of decisive importance for the patients. Without locoregional recurrence during the first two years, the overall five-year survival is 85% which decreases tremendously to 23% in case of a locoregional recurrence. Overall, this rate depends primarily on patho-histological parameters of the primary, as well as on therapeutic modalities and quality, too. For this reason, the arguments for routine neo- or adjuvant radio-(chemo-)therapy, increasingly arising during the last two years, is debatable. Global recommendations do not realize that low rates of locoregional recurrences may be achieved by surgery alone, e.g., 13% in the surgical Department of the University of Erlangen. However, these patients do include some groups with increased risk, for example, those who have positive lymph nodes along the course of a named vascular trunk (18%). These patients at increased risk may profit from adjuvant-radio-(chemo-)therapy. This is not yet, however, proven by any prospective study.

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Preoperative Radiotherapy and Radical Surgery as Combined Treatment in Rectal Cancer

Cited by 14 publications

References 1 publication

A multicentric randomized controlled trial on the impact of lengthening the interval between neoadjuvant radiochemotherapy and surgery on complete pathological response in rectal cancer (GRECCAR-6 trial): rationale and design

A multicentric randomized controlled trial on the impact of lengthening the interval between neoadjuvant radiochemotherapy and surgery on complete pathological response in rectal cancer (GRECCAR-6 trial): rationale and design

Magnetic resonance imaging in rectal cancer downstaged using neoadjuvant chemoradiation: accuracy of prediction of tumour stage and circumferential resection margin status

Decision-making in Curative Rectum Carcinoma Surgery

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