Preoperative Radiotherapy Improves Outcome in Recurrent Rectal Cancer

Vermaas, Maarten; Ferenschild, Floris T. J.; Nuyttens, J.; Marinelli, A.; Wiggers, Theo; Sijp, Joost R. M. M. van der; Verhoef, Cornelis; Graveland, Wilfried J.; Eggermont, Alexander; Wilt, Johannes H. W. de

doi:10.1007/s10350-004-0891-6

Cited by 67 publications

(47 citation statements)

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“…Preoperative chemoradiation and intraoperative radiation may improve local control and survival in patients with locally recurrent disease with acceptable morbidity. Vermaas et al [35] reported that preoperative radiotherapy for recurrent rectal cancer results in a higher number of complete resections and improved local control in comparison to patients treated without radiotherapy. High-dose rate interstitial brachytherapy delivers high-dose, highly controlled and focused radiation to specific sites of disease, thereby minimizing the degree of injury to normal tissues.…”

Section: Discussionmentioning

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: Discussionmentioning

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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“…[3][4][5][6][7][8][9]11,18,19,28,29,30,[33][34][35][36][37]41,44,46,47,[50][51][52][53]56,57 Without prior EBRT, the total dose was 40-60 Gy in most studies, with an overall range of 15-80 Gy. Conventional fractionation (1.8-2.0 Gy per fraction) was uniformly applied in 13 studies, 3,6,7,9,11,18,19,28,30,36,46,50,52 and selective use of a hypofractionated schedule (fractions of 5 Gy) was described in 2 studies. 34 described the use of re-EBRT, 7 of which specified the rate.…”

Section: Perioperative Treatment For Local Recurrencementioning

confidence: 99%

“…Thirteen studies 3,6,7,11,15,19,25,28,35,36,47,52,57 specified the total dose of IORT, which mostly ranged from 10 to 20 Gy.…”

Section: Researchmentioning

confidence: 99%

Intentionally curative treatment of locally recurrent rectal cancer: a systematic review

Tanis

Doeksen

Lanschot

2013

cjs

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Intentionally curative treatment of locally recurrent rectal cancer: a systematic reviewBackground: There is a lack of outcome data beyond local recurrence rates after primary treatment in rectal cancer, despite more information being necessary for clinical decision-making. We sought to determine patient selection, therapeutic modalities and outcomes of locally recurrent rectal cancer treated with curative intent. Methods:We searched MEDLINE (1990-2010) using the medical subject headings "rectal neoplasms" and "neoplasm recurrence, local." Selection of cohort studies was based on the primary intention of treatment and availability of at least 1 outcome variable. Results:We included 55 cohort studies comprising 3767 patients; 8 studies provided data on the rate of intentionally curative treatment from an unselected consecutive cohort of patients (481 of 1188 patients; 40%). Patients were symptomatic with pain in 50% (796 of 1607) of cases. Overall, 3088 of 3767 patients underwent resection. The R0 resection rate was 56% (1484 of 2637 patients). The rate of external beam radiotherapy was 100% in 9 studies, 0% in 5 studies, and ranged from 12% to 97% in 37 studies. Overall postoperative mortality was 2.2% (57 of 2515 patients). Five-year survival was at least 25%, with an upper limit of 41% in 11 of 18 studies including at least 50 resections. We found a significant increase in reported survival rates over time (r 2 = 0.214, p = 0.007). Conclusion:More uniformity in treatment protocols and reporting on outcomes for locally recurrent rectal cancer is warranted. The observed improvement of reported survival rates in time is probably related to better patient selection and optimized multimodality treatment in specialized centres.

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“…Local recurrence is a serious complication in the treatment of rectal cancer, since it causes disabling symptoms and is difficult to cure [1, 2]. Previous reports [3, 4 ]documented a high incidence of local recurrence up to 40% after conventional surgery. Heald et al[ 5] and Heald and Ryall [6 ]described a new concept in operative anatomy, the total mesorectal excision (TME) technique, in which the entire mesorectum is enveloped and resected.…”

Section: Introductionmentioning

confidence: 99%

Preoperative Radiotherapy Has No Value for Patients with T2–3, N0 Adenocarcinomas of the Rectum

et al. 2009

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Background: Treatment of rectal cancer with preoperative radiotherapy followed by total mesorectal excision is nowadays the standard treatment. It reduces local recurrences and improves overall survival. However, in patients with T2–3, N0 rectal cancer, the role of preoperative radiotherapy remains controversial. The aim of this study was to review the benefit of radiotherapy in T2 and T3, N0 rectal cancer patients. Methods: Between 1996 and 2003, 103 patients with T2–3, N0 rectal cancer were identified in our prospective database. This study evaluated time to local recurrence, distant metastases and overall survival. Results: Median follow-up was 4.3 years. The 5-year local control rate was 94%. The 5-year overall survival was 65%. The 5-year disease-free survival rate was 82%. Preoperative radiotherapy did not show any statistical differences. Abdominal perineal resection and T3 tumors negatively influenced overall survival (p = 0.02). Advanced age was of significant importance in overall survival. Conclusions: Preoperative radiotherapy does not seem to be of significant importance in patients with T2–3, N0 rectal cancer regarding local recurrence and survival. Since preoperative radiotherapy is associated with short- and long-term morbidity, patients with T2–3, N0 tumors should be identified and treated with surgery alone.

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Preoperative Radiotherapy Improves Outcome in Recurrent Rectal Cancer

Abstract: Preoperative radiotherapy for recurrent rectal cancer results in a higher number of complete resections and an improved local control compared with patients treated without radiotherapy. Preoperative radiotherapy should be standard treatment for patients with recurrent rectal cancer.

Cited by 67 publications

References 45 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

Intentionally curative treatment of locally recurrent rectal cancer: a systematic review

Preoperative Radiotherapy Has No Value for Patients with T2–3, N0 Adenocarcinomas of the Rectum

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