The dose-effect relationship in preoperative chemoradiation of locally advanced rectal cancer: Preliminary results of a phase III trial.

Jakobsen, Anders; Appelt, A.; Lindebjerg, Jan; Ploeen, John; Rafaelsen, Soeren Rafael; Vuong, T.

doi:10.1200/jco.2011.29.15_suppl.3512

Cited by 6 publications

(2 citation statements)

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“…A phase III trial of 50.4 Gy in 28 fractions with concomitant uftoral and leucovorin with or without an HDR endorectal boost (10 Gy in two 5-Gy fractions) in patients with high-risk disease demonstrated no difference in pCR. However, the R0 resection rate was significantly increased following the endorectal boost (90% vs. 99%; p ϭ .03) [61].…”

Section: Cmementioning

confidence: 95%

Selecting Patients With Locally Advanced Rectal Cancer for Neoadjuvant Treatment Strategies

2013

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Rectal cancer remains a significant problem worldwide. Outcomes vary significantly according to the stage of disease and prognostic factors, including the distance of the tumor from the circumferential resection margin. Accurate staging, including high-resolution magnetic resonance imaging, allows stratification of patients into low-, moderate-, and high-risk disease; this information can be used to inform multidisciplinary team decisions regarding the role of neoadjuvant therapy. Both neoadjuvant short-course radiotherapy and long-course chemoradiation reduce the risk of local recurrence compared with surgery alone, but they have little impact on survival. Although there remains a need to reduce overtreatment of those patients at moderate risk, evaluation of intensified regimens for those with high-risk disease is still required to reduce distant failure rates and improve survival in these patients with an otherwise poor prognosis. The Oncologist 2013;18:833-842Implications for Practice: The use of preoperative therapy in rectal cancer should be made in a multidisciplinary team setting based on accurate staging in combination with magnetic resonance imaging findings and patient characteristics. Circumferential resection margin involvement, extent of extramural spread, lymph node burden, extramural venous invasion and low-lying position of primary rectal cancer are all established pathological risk factors and can be identified by MRI preoperatively. This would allow stratification of patients to receive neoadjuvant therapy. Those patients with low risk rectal cancer can undergo surgery alone with favorable long-term outcomes sparing them from radiation-induced long-term toxicities. Those patients with high risk disease will need to be evaluated for intensified preoperative regimens to reduce distant failures and improve survival. Continuous research efforts are essential to identify both tissue and imaging biomarkers to predict efficacy to preoperative therapy which are lacking currently in order to optimize long-term outcome and minimize toxicities.

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