Improved sphincter preservation of low rectal cancer with high dose preoperative radiotherapy: the lyon R96-02 randomized trial

2003 ◽  
Vol 57 (2) ◽  
pp. S179-S180 ◽  
Author(s):  
J Gerard ◽  
O Chapet ◽  
P Romestaing ◽  
J Baulieux ◽  
J Hartwig ◽  
...  
2004 ◽  
Vol 22 (12) ◽  
pp. 2404-2409 ◽  
Author(s):  
Jean-Pierre Gerard ◽  
Olivier Chapet ◽  
Chantal Nemoz ◽  
Johannes Hartweig ◽  
Pascale Romestaing ◽  
...  

Purpose The potential advantage of high-dose preoperative radiotherapy to increase tumor response and improve the chance of sphincter preservation for low rectal cancer remains controversial. The aim of this trial was to evaluate the role of escalating the dose of preoperative radiation to increase sphincter-saving procedures. Patients and Methods Patients with rectal carcinoma located in the lower rectum, staged T2 or T3, Nx, or M0 with endorectal sonography, and not involving more than two-thirds circumference, were randomly assigned to one of two groups: preoperative external-beam radiotherapy (EBRT; 39 Gy in 13 fractions over 17 days) versus the same EBRT with boost (85 Gy in three fractions) using endocavitary contact x-ray. Results Between 1996 and 2001, 88 patients were enrolled onto the study. A significant improvement was seen in favor of the contact x-ray boost for complete clinical response (24% v 2%) and for a complete or near-complete sterilization of the operative specimen (57% v 34%). A significant increase in sphincter preservation was observed in the boost group (76% v 44%; P = .004). At a median follow-up of 35 months, there was no difference in morbidity, local relapse, and 2-year overall survival. Conclusion A dose escalation with endocavitary irradiation provides increased tumor response and sphincter preservation with no detrimental effect on treatment toxicity and early clinical outcome.


Brachytherapy ◽  
2008 ◽  
Vol 7 (2) ◽  
pp. 103
Author(s):  
Te Vuong ◽  
Sender Liberman ◽  
Carole Richard ◽  
Sergio Faria ◽  
Kevin Waschke ◽  
...  

2020 ◽  
Vol 24 (10) ◽  
pp. 1025-1034 ◽  
Author(s):  
G. Sun ◽  
Z. Lou ◽  
H. Zhang ◽  
G. Y. Yu ◽  
K. Zheng ◽  
...  

Abstract Background Conformal sphincter preservation operation (CSPO) is a new surgical procedure for very low rectal cancers (within 4–5 cm from the anal verge). CSPO preserves more of the dentate line and distal rectal wall and also avoids injuring nerves in the intersphincteric space, resulting in satisfactory anal function after resection. The aim of this study was to analyze the short-term surgical results and long-term oncological and functional outcomes of CSPO. Methods Consecutive patients with very low rectal cancer, who had CSPO between January 2011 and October 2018 at Changhai Hospital, Shanghai were included. Patient demographics, clinicopathological features, oncological outcomes and anal function were analyzed. Results A total of 102 patients (67 men) with a mean age of 56.9 ± 10.8 years were included. The median distance of the tumor from the anal verge was 3 (IQR, 3–4) cm. Thirty-five patients received neoadjuvant chemoradiation (nCRT). The median distal resection margin (DRM) was 0.5 (IQR, 0.3–0.8) cm. One patient had a positive DRM. All circumferential margins were negative. There was no perioperative mortality. The postoperative complication rate was 19.6%. The median duration of follow-up was 28 (IQR, 12–45.5) months. The local recurrence rate was 2% and distant metastasis rate was 10.8%. The 3-year overall survival and disease-free survival rates were 100% and 83.9%, respectively. The mean Wexner incontinence and low anterior resection syndrome scores 12 months after ileostomy reversal were 5.9 ± 4.3, and 29.2 ± 6.9, respectively. Conclusions For patients with very low rectal cancers, fecal continence can be preserved with CSPO without compromising oncological results.


2020 ◽  
Vol 145 ◽  
pp. 223-228 ◽  
Author(s):  
Jasenko Krdzalic ◽  
Regina G.H. Beets-Tan ◽  
Sanne M.E. Engelen ◽  
Joost van Griethuysen ◽  
Max J. Lahaye ◽  
...  

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