Preoperative short-course radiotherapy with delayed surgery in primary rectal cancer

Pettersson, David; Holm, Torbjörn; Iversen, Henrik; Blomqvist, Lennart; Glimelius, Bengt; Martling, Anna

doi:10.1002/bjs.7796

Cited by 154 publications

(115 citation statements)

References 93 publications

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“…However, if SCPRT is followed by a gap of several weeks prior to surgery, then significant downstaging does occur [19]. Rectal cancers can be described as 'operable' if disease does not threaten or involve the surgical CRM.…”

Section: Introductionmentioning

confidence: 99%

Neoadjuvant Treatment Strategies for Locally Advanced Rectal Cancer

Gollins

Sebag‐Montefiore

2016

Clinical Oncology

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Improved surgical technique plus selective pre-operative radiotherapy, has decreased rectal cancer pelvic local recurrence (LR) from historically 25%, down to approximately 5-10%. However, this improvement has not reduced distant metastatic relapse, the main cause of death and a key issue in rectal cancer management.The current standard is local pelvic treatment (surgery +/-pre-operative radiotherapy) followed by adjuvant chemotherapy (AC), depending on resection histology. For circumferential resection margin (CRM)-threatened cancer on baseline MRI, downstaging long-course pre-operative chemoradiation (LCPCRT) is generally used. However, for non-CRM threatened disease, varying approaches are currently adopted in the UK, including straight to surgery (STS), short-course pre-operative radiotherapy (SCPRT) and LCPCRT.Clinical trials are investigating intensification of concurrent chemoradiation. There is also increasing interest in investigating pre-operative neoadjuvant chemotherapy (NAC) as a way of exposing micro-metastatic disease to full dose systemic chemotherapy as early as possible and potentially reducing metastatic relapse.Phase II trials suggest that this strategy is feasible, with promising histological response and low rates of tumour progression during NAC. Phase III trials are needed to determine the benefit of NAC when added to standard therapy and also to determine if it can be used instead of neoadjuvant radiotherapy based schedules.

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Section: Introductionmentioning

confidence: 99%

Neoadjuvant Treatment Strategies for Locally Advanced Rectal Cancer

Gollins

Sebag‐Montefiore

2016

Clinical Oncology

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“…В нашем исследовании частота возникновения токсичности III-IV степени тяжести сравнима с пока-зателями, представленными в публикациях по пролон-гированной ХЛТ (14,6-18,2 %), но выше, чем 3,2-5,4 % при проведении короткого курса ЛТ [13][14][15]. Проктит III степени зарегистрирован у 3 (3,7 %) пациентов, из них у 1 впоследствии развилась несостоятельность анастомоза.…”

Section: Discussionunclassified

Preoperative Short-Course Radiotherapy Combined With Chemotherapy, Local Hyperthermia and Delayed Surgery in Treatment of Rectal Cancer: Phase Ii Trial

Расулов¹,

Гордеев²,

Иванов³

et al. 2016

Onkol. koloproktol.

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“…Small bowel toxicity with an increased risk for bowel obstruction is probably the most frequent side effect (5,36,37). The incidence of severe radio toxicity with leukopenia, abdominal pain and diarrhea is around 5% (38,39). The late effects of RT may add to the complications of pelvic surgery.…”

Section: The Biological Phasementioning

confidence: 99%

“…The risk for secondary cancer is increased after irradiation (36) Several studies have demonstrated that LRT and SRT with delay have comparable down staging effect and reduction in the rate of local recurrence (38)(39)(40). There is a clear doseresponse between the RT-dose and the tumour down staging when the same fractionations are compared (35,41).…”

Section: The Biological Phasementioning

confidence: 99%

Response to neoadjuvant treatment in rectal cancer surgery

Loftås

2016

Linköping University Medical Dissertations

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Rectal cancer is one of the three most common malignancies in Sweden with an annual incidence of about 2000 cases. Current treatment consists of surgical resection of the rectum including the loco-regional lymph nodes in the mesorectum. In advanced cases, neoadjuvant chemo-radiotherapy (CRT) prior to the operative treatment reduces local recurrences and enables surgery. The neoadjuvant treatment can also eradicate the tumour completely, i.e. complete response. This research project was designed to investigate the effects of preoperative radiotherapy/ CRT and analyze methods to predict response to CRT. Study I investigated the expression of the FXYD-3 protein with immunohistochemistry in rectal cancer, with or without preoperative radiotherapy. The results from the total cohort showed that, strong FXYD-3 expression was correlated to infiltrative tumour growth (p = 0.02). In the radiotherapy group, strong FXYD-3 expression was related to an unfavourable prognosis (p = 0.02). Tumours with strong FXYD-3 expression had less tumour necrosis (p = 0.02) after radiotherapy. FXYD-3 expression in the primary tumour was increased compared to normal mucosa (p=0.008). We concluded that FXYD-3 expression was a prognostic factor in patients receiving preoperative radiotherapy for rectal cancer. Study II investigated FXYD-3 expression in tumours that developed local recurrences following surgery and compared this with expression in tumours that did not develop local recurrences. There was no difference in the expression of FXYD-3 between the group that developed local recurrences and the group that did not develop local recurrences. There was no difference in survival between those with strong or weak FXYD-3 expression. We concluded that this study could not confirm the findings from study 1 i.e. that FXYD-3 expression has prognostic significance in rectal cancer. Study III was a register-based study on the incidence and effects of complete response to neoadjuvant treatment. Eight per cent of the patients with adequate CRT to achieve complete response also had a complete histological response of the luminal tumor in the resected bowel. Sixteen per cent of that group had remaining lymph node metastases in the operative specimen. Chemotherapy together with radiotherapy doubled the chance of complete response in the luminal tumour. Patients with remaining lymph node metastases had a lower survival rate compared to those without. We concluded that residual nodal involvement after neoadjuvant treatment was an important factor for reduced survival after complete response in the luminal tumour. Study IV followed up the results from the previous study by re-evaluating magnetic resonance imaging (MRI)- images in patients with complete tumour response. Two experienced MRI radiologists performed blinded re-staging of post CRT MR- images from patients with complete response in the luminal tumour. One group with lymph node metastases and another one without were studied and the results compared with the pathology reports. The sensitivity, spe...

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Preoperative short-course radiotherapy with delayed surgery in primary rectal cancer

Abstract: The SRT-delay schedule was a feasible alternative with low toxicity. The study indicated a downstaging effect of SRT if surgery was delayed.

Cited by 154 publications

References 93 publications

Neoadjuvant Treatment Strategies for Locally Advanced Rectal Cancer

Neoadjuvant Treatment Strategies for Locally Advanced Rectal Cancer

Preoperative Short-Course Radiotherapy Combined With Chemotherapy, Local Hyperthermia and Delayed Surgery in Treatment of Rectal Cancer: Phase Ii Trial

Response to neoadjuvant treatment in rectal cancer surgery

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