Improved Survival with Preoperative Radiotherapy in Resectable Rectal Cancer

2017 ◽  
Author(s):  
Arielle C. Dubose ◽  
Benjamin D. Lee ◽  
SreyRam Kuy
Keyword(s):  
Rectal Cancer ◽  
Radiation Therapy ◽  
Clinical Case ◽  
Preoperative Radiotherapy ◽  
Distant Recurrence ◽  
Preoperative Radiation ◽  
Cancer Trial ◽  
Resectable Rectal Cancer ◽  
Study Intervention

The landmark Swedish Rectal Cancer Trial examined whether preoperative radiation given to patients <80 years of age with resectable rectal cancer impacted rate of local recurrence and survival compared with immediate surgical resection. This trial demonstrated that neoadjuvant radiation therapy decreased rates of local and distant recurrence and improved survival. This chapter describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case.

Influence of the Interval Between Preoperative Radiation Therapy and Surgery on Downstaging and on the Rate of Sphincter-Sparing Surgery for Rectal Cancer: The Lyon R90-01 Randomized Trial

1999 ◽  
Vol 17 (8) ◽  
pp. 2396-2396 ◽  
Author(s):  
Yves Francois ◽  
Chantal J. Nemoz ◽  
Jacques Baulieux ◽  
Jacques Vignal ◽  
Jean-Paul Grandjean ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Radiation Therapy ◽  
Preoperative Radiotherapy ◽  
Short Interval ◽  
Group Versus ◽  
Optimal Timing ◽  
Preoperative Irradiation ◽  
Preoperative Radiation ◽  
Term Survival ◽  
Group V

PURPOSE: The optimal timing of surgery after preoperative radiotherapy in rectal cancer is unknown. The aim of this trial was to evaluate the role of the interval between preoperative radiotherapy and surgery. PATIENTS AND METHODS: Patients with rectal carcinoma accessible to rectal digital examination, staged T2 to T3, NX, M0, were randomized before radiotherapy (39 Gy in 13 fractions) into two groups: in the short interval (SI) group, surgery had to be performed within 2 weeks after completion of radiation therapy, compared with 6 to 8 weeks in the long interval (LI) group. Between 1991 and 1995, 201 patients were enrolled onto the study. RESULTS: A long interval between preoperative radiotherapy and surgery was associated with a significantly better clinical tumor response (53.1% in the SI group v 71.7% in the LI group, P = .007) and pathologic downstaging (10.3% in the SI group v 26% in the LI group, P = .005). At a median follow-up of 33 months, there were no differences in morbidity, local relapse, and short-term survival between the two groups. Sphincter-preserving surgery was performed in 76% of cases in the LI group versus 68% in the SI group (P = 0.27). CONCLUSION: A long interval between preoperative irradiation and surgery provides increased tumor downstaging with no detrimental effect on toxicity and early clinical results. When sphincter preservation is questionable, a long interval may increase the chance of a successful sphincter-saving surgery.

Adverse Effects of Preoperative Radiation Therapy for Rectal Cancer: Long-Term Follow-Up of the Swedish Rectal Cancer Trial

2005 ◽  
Vol 23 (34) ◽  
pp. 8697-8705 ◽  
Author(s):  
Helgi Birgisson ◽  
Lars Påhlman ◽  
Ulf Gunnarsson ◽  
Bengt Glimelius
Keyword(s):  
Rectal Cancer ◽  
Radiation Therapy ◽  
Adverse Effects ◽  
Bowel Obstruction ◽  
Primary Treatment ◽  
Preoperative Irradiation ◽  
Preoperative Radiation ◽  
Cancer Trial ◽  
Preoperative Radiation Therapy ◽  
Increased Risk

Purpose To analyze the occurrence of subacute and late adverse effects in patients treated with preoperative irradiation for rectal cancer. Patients and Methods The study population included 1,147 patients randomly assigned to preoperative radiation therapy or surgery alone in the Swedish Rectal Cancer Trial conducted 1987 through 1990. Patient data were matched against the Swedish Hospital Discharge Register to identify patients admitted to hospital after the primary treatment of the rectal cancer. Patients with known residual disease were excluded, and patients with a recurrence were censored 3 months before the date of recurrence. Relative risks (RR) with 95% CIs were calculated. Results Irradiated patients were at increased risk of admissions during the first 6 months from the primary treatment (RR = 1.64; 95% CI, 1.21 to 2.22); these were mainly for gastrointestinal diagnoses. Overall, the two groups showed no difference in the risk of admissions more than 6 months from the primary treatment (RR = 0.95; 95% CI, 0.80 to 1.12). Regarding specific diagnoses, however, RRs were increased for admissions later than 6 months from the primary treatment in irradiated patients for unspecified infections, bowel obstruction, abdominal pain, and nausea. Conclusion Gastrointestinal disorders, resulting in hospital admissions, seem to be the most common adverse effect of short-course preoperative radiation therapy in patients with rectal cancer. Bowel obstruction was the diagnosis of potentially greatest importance, which was more frequent in irradiated than in nonirradiated patients.

Enhanced Tumorocidal Effect of Chemotherapy With Preoperative Radiotherapy for Rectal Cancer: Preliminary Results—EORTC 22921

2005 ◽  
Vol 23 (24) ◽  
pp. 5620-5627 ◽  
Author(s):  
Jean-François Bosset ◽  
Gilles Calais ◽  
Laurent Mineur ◽  
Philippe Maingon ◽  
Ljiljana Radosevic-Jelic ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Preoperative Radiotherapy ◽  
Tumor Type ◽  
Preoperative Radiation ◽  
Tumor Differentiation ◽  
Stage Number ◽  
Preliminary Results ◽  
The Impact ◽  
Pathologic Parameters

Purpose The European Organisation for Research and Treatment of Cancer (EORTC) trial evaluated the addition of chemotherapy (CT) to preoperative radiation (preop RT) and the value of postoperative CT for improving the survival in patients with T3-4 resectable rectal cancer. Patients were allocated to the following four arms: arm 1, preop RT 45 Gy in 5 weeks; arm 2, preop RT plus two 5-day CT courses (fluorouracil 350 mg/m2/d and leucovorin 20 mg/m2/d) in the first and fifth week of RT; arm 3, preop RT plus four postoperative CT courses; and arm 4, preop RT and CT plus postoperative CT. We investigated the effect of adding CT on the pathologic parameters. Patients and Methods One thousand eleven patients were entered onto the trial; 505 received preop RT (arms 1 and 3), and 506 received preop RT-CT (arms 2 and 4). We analyzed the differences in tumor size, tumor node stage, number of retrieved nodes, and histologic features such as lymphatic, venous, and perineural invasions, tumor differentiation, and tumor type. Results After preop RT-CT, tumors were smaller (P < .0001), had less advanced pT (P < .001) and pN stages (P < .001), had small numbers of examined nodes (P = .046), and less frequent LVN invasions (P ≤ .008). Mucinous tumors increased after preop RT-CT (P < .001). Conclusion In patients with rectal cancer, preliminary results of EORTC Trial 22921 indicate that the addition of CT to preop RT induces downsizing, downstaging, and significant changes in histologic characteristics. Longer follow-up is needed to assess the impact on local control and survival.

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