Radiation in the Treatment of Rectal Cancer

Binkley, George E.

doi:10.1097/00000658-192912000-00007

Cited by 11 publications

(3 citation statements)

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“…The idea of using radiation as the primary curative treatment of rectal cancer and reserving surgery for salvage following treatment failure was introduced almost a century ago. 87 For most of the 20th century, organ preservation using radiotherapy or chemoradiotherapy in rectal cancer was only pursued anecdotally in patients who refused or were unfit for surgery. Habr-Gama et al 88 was the first to report that a W&W approach for patients with rectal cancer with a clinical CR (cCR) to chemoradiotherapy resulted in equivalent oncologic outcomes compared with patients treated with TME who had a pCR in the surgical specimen.…”

Section: Watch-and-wait Approach In Rectal Cancer: Controversies and ...mentioning

confidence: 99%

The Multimodal Management of Locally Advanced Rectal Cancer: Making Sense of the New Data

Zwart

Hotca²,

Hospers

et al. 2022

American Society of Clinical Oncology Educational Book

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In the past 40 years, the treatment of locally advanced rectal cancer has evolved with the addition of radiotherapy or chemoradiotherapy and providing (neo)adjuvant systemic chemotherapy to major surgery. However, recent trends have focused on improving our ability to risk-stratify patients and tailoring treatment to achieve the best oncologic outcome while limiting the impact on long-term quality of life. Therefore, there has been increasing interest in pursuing a watch-and-wait approach to achieve organ preservation. Several retro- and prospective studies suggest safety of the watch-and-wait approach, though it is still considered controversial due to limited clinical evidence, concerns about tumor regrowth, and subsequent distant progression. To further reduce treatment, MRI risk stratification, together with patient characteristics and patient preferences, can guide personalized treatment and reserve radiation and chemotherapy for a select patient population. Ultimately, improved options for reassessment during neoadjuvant treatment may allow for more adaptive therapy options based on treatment response. This article provides an overview of some major developments in the multimodal treatment of locally advanced rectal cancer. It reviews some relevant, controversial issues of the watch-and-wait approach and opportunities to personally tailor and reduce treatment. It also reviews the overall neoadjuvant treatment, including total neoadjuvant therapy trials, and how to best optimize for a potential complete response. Finally, it provides an algorithm as an example of how such a personalized, tailored, adaptive, and reduced treatment could look like in the future.

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Section: Watch-and-wait Approach In Rectal Cancer: Controversies and ...mentioning

confidence: 99%

The Multimodal Management of Locally Advanced Rectal Cancer: Making Sense of the New Data

Zwart

Hotca²,

Hospers

et al. 2022

American Society of Clinical Oncology Educational Book

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“…The occasional eradication of rectal cancer by radiation therapy has been known for decades. Attempts to cure rectal cancer with radiation alone were popular at the beginning of the twentieth century, when the mortality and morbidity of rectal cancer surgery were prohibitive [37]. The difficulty in identifying patients with a true complete response and increased safety of surgery ultimately led to the abandonment of the idea of treating cancer with radiation alone.…”

Section: Accidental Versus Intentional Wwmentioning

confidence: 99%

Rectal Cancer: Nonoperative Management

Garcia‐Aguilar

Perez

2021

The ASCRS Textbook of Colon and Rectal Surgery

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Concepts• A proportion of patients with rectal cancer managed by neoadjuvant chemoradiation may achieve complete disappearance of the primary tumor (complete clinical response) during assessment of response after treatment completion. • Establishing a complete clinical response requires the combination of clinical, endoscopic, and radiological findings consistent with the absence of residual cancer at the site of the original cancer. • Patients that achieve a complete clinical response have been considered for organ preservation strategy with strict surveillance and no immediate surgery (Watch and Wait) to avoid the potential morbidity, mortality, requirement for stomas, and functional consequences of a proctectomy. • Patients that achieve a complete clinical response and are managed by the Watch and Wait strategy have a 25% risk for developing local regrowth of the primary tumor. • The majority of local regrowths are amenable to successful salvage proctectomy with negative resection margins (R0). • Patients that achieve a cCR and are managed by Watch and Wait have similar overall survival rates when compared to patients with pCR managed by radical proctectomy. Disease-free survival rates are superior for patients undergoing radical proctectomy due to the 25% risk of local regrowth following WW requiring salvage proctectomy. • Functional outcomes and quality of life appear to be improved among patients with complete clinical response managed by Watch and Wait when compared to proctectomy.

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“…1 Neoadjuvant radiotherapy was introduced by Janeway and Quick in 1917, 2 making surgery a salvage procedure for resistant cancers. 3 With the introduction of abdominoperineal resection (APR), surgery became the primary treatment 4 ; survival was improved, although with high morbidity, a permanent colostomy, and unacceptable local recurrence (LR) rates. 5,6 Preoperative external beam irradiation with sphincter preservation was first performed in 1976.…”

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confidence: 99%

Longitudinal Analysis of Local Recurrence and Survival After Transanal Abdominal Transanal Radical Proctosigmoidectomy for Low Rectal Cancer Treated With Neoadjuvant Chemoradiation Therapy

Marks,

Reif de Paula,

Saidi

et al. 2023

Diseases of the Colon &Amp; Rectum

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BACKGROUND: The transanal abdominal transanal radical proctosigmoidectomy was developed in 1984 as a sphincter preservation surgery in low rectal cancers after preoperative radiation. While serving as a catalyst for disruptive sphincter preservation surgery, it continues to be used and evolve. With the controversy over safety and local recurrence in other sphincter preserving surgery, review of transanal abdominal transanal radical proctosigmoidectomy long-term oncologic outcomes is warranted. OBJECTIVE: To assess local after transanal abdominal transanal radical proctosigmoidectomy after neoadjuvant chemoradiation. DESIGN: Retrospective cohort study of a prospectively maintained database. SETTINGS: Tertiary rectal cancer referral center. PATIENTS: Low adenocarcinoma (≤5 cm anorectal ring) receiving neoadjuvant chemoradiation then transanal abdominal transanal radical proctosigmoidectomy for curative resection between 1998-2021. MAIN OUTCOME MEASURES: Local recurrence rates and overall survival rates. RESULTS: Of 255 included, 67.8% were male (n = 173), mean 58.7 years old (standard deviation 11.5), with mean body mass index 27.1 kg/m2 (standard deviation, 5.4) and 50.2% (n = 128) American Society of Anesthesiology II. The mean tumor size was 4.8 cm (standard deviation 1.9), majority clinical T3 (81.8%, n = 184) and 52.1% had nodal disease (n = 100). The median radiation dose was 5400 cGy, with 73.7% (n = 149) achieving good response. 90.2% (n = 230) had minimally invasive surgery. Complete total mesorectal excision rate was 94.3% (n = 83/87) and 100% (n = 255) had negative distal margins. The mean examined lymph nodes were 13.9 (standard deviation, 10.7). After median follow-up of 55.4 months, 5.1% (n = 13) patients developed local recurrence, at median time of 29.6 months. The 5-year overall survival was 84.1% (95% CI 78.8-89.4). LIMITATIONS: Retrospective review with risk of bias and lack of generalizability. CONCLUSIONS: In this longitudinal study, the transanal abdominal transanal radical proctosigmoidectomy demonstrated excellent long-term locoregional control and survival in very low rectal cancers. The superior transanal abdominal transanal radical proctosigmoidectomy outcomes are durable over time, warranting expansion of the sphincter preserving surgery technique.

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Radiation in the Treatment of Rectal Cancer

Cited by 11 publications

References 0 publications

The Multimodal Management of Locally Advanced Rectal Cancer: Making Sense of the New Data

The Multimodal Management of Locally Advanced Rectal Cancer: Making Sense of the New Data

Rectal Cancer: Nonoperative Management

Longitudinal Analysis of Local Recurrence and Survival After Transanal Abdominal Transanal Radical Proctosigmoidectomy for Low Rectal Cancer Treated With Neoadjuvant Chemoradiation Therapy

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