Short-course radiotherapy, with elective delay prior to surgery, in patients with unresectable rectal cancer who have poor performance status or significant co-morbidity

Hatfield, Paul; Hingorani, Mohan; Radhakrishna, Ganesh; Cooper, R.; Melcher, Alan; Crellin, A.; Kwok‐Williams, Michelle; Sebag‐Montefiore, David

doi:10.1016/j.radonc.2009.04.007

Cited by 118 publications

(81 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Another variation of the preoperative short-course radiation strategy involves delayed rather than immediate surgery, which has been found in retrospective studies to be well tolerated, with greater tumour regression rates [39][40][41] .…”

Section: Evidence Summarymentioning

confidence: 99%

Eastern Canadian Colorectal Cancer Consensus Conference 2017

et al. 2018

View full text Add to dashboard Cite

The annual Eastern Canadian Gastrointestinal Cancer Consensus Conference 2017 was held in St. John's, Newfoundland and Labrador, 28-30 September. Experts in radiation oncology, medical oncology, surgical oncology, and cancer genetics who are involved in the management of patients with gastrointestinal malignancies participated in presentations and discussion sessions for the purpose of developing the recommendations presented here. This consensus statement addresses multiple topics in the management of gastric, rectal, and colon cancer, including ■ identification and management of hereditary gastric and colorectal cancer (crc); ■ palliative systemic therapy for metastatic gastric cancer; ■ optimum duration of preoperative radiation in rectal cancer-that is, short-compared with long-course radiation; ■ management options for peritoneal carcinomatosis in crc; ■ implications of tumour location for treatment and prognosis in crc; and ■ new molecular markers in crc.

show abstract

Section: Evidence Summarymentioning

confidence: 99%

Eastern Canadian Colorectal Cancer Consensus Conference 2017

et al. 2018

View full text Add to dashboard Cite

show abstract

“…In fact, the optimal timing interval of surgery remains controversial. Short-course preoperative radiation with delayed surgery has been shown to increase pathologic complete response (pCR) rate and induce tumour down-staging rate in both randomized and observational studies in recent years (Radu et al, 2008;Hatfield et al, 2009;Pettersson et al, 2010). Particularly worth mentioning is that preoperative radiotherapy for rectal carcinoma is worrying in developing Asia country, because this regimen was with the high rate of local recurrence (Lee et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

Short-course Versus Long-course Preoperative Radiotherapy plus Delayed Surgery in the Treatment of Rectal Cancer: a Meta-analysis

Liu¹,

Zhou²,

Chen³

et al. 2015

Asian Pacific Journal of Cancer Prevention

View full text Add to dashboard Cite

Background: Short-course preoperative radiation (SCRT) with delayed surgery was found to increase pathologic complete response (pCR) rates in several trials. However, there was no clear answer on whether SCRT or long-course chemo-radiotherapy (LCRT) is more effective. Therefore we conducted this meta-analysis to evaluate the safety and efficacy of SCRT versus LCRT, both with delayed surgery, for treatment of rectal In terms of sphincter preservation rate, local recurrence rate, grade 3~4 acute toxicity, R0 resection rate and downstaging rate, SCRT with delayed surgery is as effective as LCRT with delayed surgery for management of rectal cancer. LCRT significantly increased pCR rate compared with SCRT. Due to risk of bias and imprecision, further multi-center large sample RCTs were needed to confirm this conclusion.

show abstract

“…Further extension of the interval following SCPRT to surgery of at least 6 weeks does demonstrate significant histopathogical response and downstaging. [33][34][35] A small randomised controlled trial in patients with resectable stage II and III rectal adenocarcinoma 36 compared the downstaging achieved after long-course CRT or SCPRT, followed by delayed surgery (see Table 1). Surgery was performed 6 weeks after in both groups.…”

Section: 24mentioning

confidence: 99%

“…Two small retrospective studies in locally advanced tumours 33,34 (with 46 and 41 patients, respectively) and a prospective phase III trial 35 show that short-course RT with delayed surgery for several weeks can result in substantial downstaging and achieve an R0 resection for most patients. Hence, several alternative sequencing approaches have been examined.…”

Section: Developments In Short-course Preoperative Radiotherapy Integmentioning

confidence: 99%

How to Select for Preoperative Short-course Radiotherapy, While Considering Long-course Chemoradiotherapy or Immediate Surgery, and Who Benefits?

Glynne-Jones¹,

Dt²,

Moran³

et al. 2014

European Oncology &Amp; Haematology

View full text Add to dashboard Cite

The management of patients with locally advanced rectal cancer (LARC) has evolved with the aim of reducing local recurrence and improving survival. Current practice has developed from refinements in surgical technique, the availability of different types of preoperative imaging, the selective or blanket use of neoadjuvant treatment (usually radiation) and sophisticated efforts exploring multimodality treatments to achieve organ preservation. Both short-course preoperative radiotherapy (SCPRT) and long-course chemoradiation (CRT) are considered standard neoadjuvant strategies, which are advocated in different parts of the world. New techniques in the delivery of radiotherapy, such as intensity-modulated radiotherapy (IMRT), may allow more precise dosing to the target volume (tumour and/or locoregional lymph nodes) and limit radiation doses to critical normal structures; however, current schedules of SCPRT and CRT impact on late function, and if they do not improve survival in resectable cancers, can they be omitted in selected cases? KeywordsRectal adenocarcinoma, neoadjuvant radiation, chemoradiation, chemotherapy, short-course preoperative radiation, long-course chemoradiation Disclosure: Rob Glynne-Jones has received honoraria for lectures and advisory boards and has been supported in attending international meetings in the last five years by Eli Lilly, Merck, Pfizer, Sanofi-Aventis and Roche. He has received unrestricted grants for research from Merck-Serono, Sanofi-Aventis and Roche. He is principal investigator of a randomised phase II neoadjuvant chemotherapy study in the UK called BACCHUS. David Tan In patients with locally advanced rectal cancer (LARC), not involving the mesorectal fascia (MRF), surgery with total mesorectal excision (TME) is the standard of care. Prior to the TME era, high rates of local recurrence (LR) were observed after radical surgery, and 10-40 % of patients required a permanent stoma, even for tumours arising in the mid/upper rectum. In the 1990s, randomised trials 1-3 established shortcourse preoperative pelvic radiotherapy (SCPRT) using 5 x 5 Gy as a component of the curative treatment of resectable and early rectal cancers. These historical trials reported LR rates of 20-30 % after surgery alone, reflecting the suboptimal surgical practice at the time.Two subsequent trials examined whether SCPRT simply compensated for poor surgical technique, i.e. whether SCPRT still reduced LR if TME was performed. By then, it was recognised that the risk of LR, after a potentially curative resection, is mainly explained by microscopic tumour cells within 1 mm of the circumferential resection margin (CRM). 4 Hence, in the control group in the event of a histopathological involved CRM, postoperative RT or chemoradiotherapy was intended in the Dutch TME study 5 and CR07 trial,6 respectively. Both trials confirmed a reduction in LR, but overall survival (OS) was not improved, and the risk of metastases predominated over LR. [5][6][7][8] During the same period, the strategy of postoperativ...

show abstract

Short-course radiotherapy, with elective delay prior to surgery, in patients with unresectable rectal cancer who have poor performance status or significant co-morbidity

Cited by 118 publications

References 20 publications

Eastern Canadian Colorectal Cancer Consensus Conference 2017

Eastern Canadian Colorectal Cancer Consensus Conference 2017

Short-course Versus Long-course Preoperative Radiotherapy plus Delayed Surgery in the Treatment of Rectal Cancer: a Meta-analysis

How to Select for Preoperative Short-course Radiotherapy, While Considering Long-course Chemoradiotherapy or Immediate Surgery, and Who Benefits?

Contact Info

Product

Resources

About