Rectal cancer irradiation. Long course, short course or something else?

Glimelius, Bengt

doi:10.1080/02841860601019413

Cited by 31 publications

(21 citation statements)

References 37 publications

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“…Currently considerably more is known concerning late morbidity related to SCPRT than LCPCRT because of longer follow-up periods in relevant studies [20]. Late adverse events associated with radiotherapy included bowel obstruction, bowel dysfunction presenting as faecal incontinence to gas, loose or solid stool, evacuation problems or urgency and sexual dysfunction [21,22].…”

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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“…However, retrospective data suggest that the 5 x 5 Gy regime can cause down sizing and complete response if surgery is delayed [26]. Prospective evaluating of the timing of surgery after 5 x 5 Gy is ongoing in Sweden together with a comparison to long course [27]. It will remain an unanswered question whether the nine patients in our study with a peroperatively fixed tumour and later local failure would have benefitted from delayed surgery or long course radiation.…”

Section: A C C E P T E D Article In Pressmentioning

confidence: 96%

Clinical outcome in 520 consecutive Danish rectal cancer patients treated with short course preoperative radiotherapy

Jensen

Altaf

Harling

et al. 2010

European Journal of Surgical Oncology (EJSO)

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“…This opens the question whether patients with T2-T3 resectable RC can be downstaged to T1-T2 with subsequent transanal endoscopic microresection (TEM) resulting in decreased morbidity in this group of patients. Whether a shortcourse RT can result in down-staging the tumour with delayed resection is now being investigated in a Swedish randomized phase III trial in which patients with resectable RC are randomized to RT with 25 Gy/5 fx immediately followed by TME, 25 Gy/5 fx and TME after 4 weeks or 50 Gy/25 fx and TME after 4 weeks [25].…”

Section: Discussionmentioning

confidence: 99%