Residual, recurrent, or unresectable gastrointestinal cancer. Role of radiation in single or combined modality treatment

Abstract

When conventional modalities of external beam irradiation and chemotherapy ± resection are used in the treatment of locally advanced gastrointestinal malignancies, although useful palliation can be achieved in many patients, cure and long‐term survival is infrequent. Aggressive combined modality approaches have recently encorporated irradiation boost techniques with intraoperative electrons or intraoperative or transcatheter brachytherapy. Both local control and long‐term survival appear to be improved when compared with results achieved with conventional treatment. Randomized trials are needed to determine if the observed differences are real or due to differences in case selection.

Irradiation with and without Razoxane in the Treatment of Incompletely Resected or Inoperable Recurrent Rectal Cancer

“…A median survival around 12 months was a common value in the literature until 1994, even for combination chemoradiotherapy with 5-FU-based regimens [4,6,7,11,27,39]. In the present study, the group with radiation therapy alone achieved a median survival which is comparable to the razoxane-treated group of the previous study, the survival in the razoxane arm remained at a similar value as seen earlier.…”

“…Considering the experience from the last 2 decades, radiotherapy alone is clearly inferior compared to combined treatment approaches [3,9,11,18,20,23,34,41], and should rather not be used in recurrent rectal cancer. This also applies to the adjuvant setting [42].…”

Multi-Targeted Approach to Treatment of Cancer

“…At the time of exploration, the margins of unresectable and/or residual disease are often marked with radiopaque clips to facilitate treatment planning. Most patients with locally advanced unresectable disease receive a combination of chemotherapy and RT to take advantage of the radiation-sensitizing properties of certain chemotherapeutic agents, although there are few data validating this approach (Ben- David et al 2006;Gunderson et al 1985). With or without chemotherapy, the first site of failure in patients with a margin-positive resection is usually locoregional.…”

Prevention and management of recurrent rectal cancer

“…Palliation can often be achieved with a combination of external beam irradiation and chemotherapy with or without resection. Local control and long term survival occur in only about 5% of patients because of the limited radiation tolerance of surrounding organs and tissue [22]. In these cases, the patients are initially treated with at least 5000 rads of external beam radiation and subsequently explored [23].…”