scholarly journals Preoperative vs postoperative radiotherapy in the management of rectal cancer: A systematic review

2021 ◽  
Vol 12 (1) ◽  
pp. 17-23
Author(s):  
Muhammad Fauzi Siregar
Keyword(s):  
Rectal Cancer ◽  
Overall Survival ◽  
Locoregional Recurrence ◽  
Randomized Clinical Trials ◽  
Preoperative Radiotherapy ◽  
Postoperative Radiotherapy ◽  
Disease Free Survival ◽  
Free Survival ◽  
Radiotherapy Group ◽  
Disease Free

Purpose. The objective of this study is to review randomized clinical trials systematically that compare the outcomes of preoperative and postoperative radiotherapy in the management of rectal cancer regarding locoregional recurrance, disease free survival and overall survival.Methods. The relevant randomized clinical trials are searched via online databases such as Pubmed, Ebsco, and Proquest. RCTs publised in English between 2000 until 2020 are selected and reviewed systematically.Result. Locoregional recurrence at 5 years was statistically lower in preoperative radiotherapy group than in postoperative radiotherapy group based on two studies.  Disease free survival at 5-years was statistically higher in preoprative radiotherapy group than the postoperative one based on two studies. Overall survival at 5 years was not statistically significant between two groups for each study.Conclusion. Preoperative radiotherapy is superior to postoperative radiotherapy for controlling locoregional recurrence and disease free survival, but both are equal in overall survival. 

Ten fractions of preoperative radiotherapy for advanced rectal cancer: Is it a new protocol to follow?

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 439-439
Author(s):  
J. Gu
Keyword(s):  
Rectal Cancer ◽  
Preoperative Radiotherapy ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Complete Response ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Free Survival ◽  
Short Course ◽  
Disease Free

439 Background: This study is a retrospective analysis to investigate the efficiency of short-course preoperative radiotherapy following standardized total mesorectal excision (TME) for locally advanced rectal cancer. Methods: Clinical data of locally advanced mid-low rectal cancer who received TME in Beijing Cancer Hospital from 2001 to 2005 were collected retrospectively. Survival analysis was performed between patients who had TME following short-course preoperative radiotherapy (biological equivalent dose: 36Gy) or TME alone at the corresponding period. Results: Two hundred and sixty-three patients were eligible for analysis including 101 patients who received TME plus preoperative radiotherapy (PRT group) and 162 patients with TME alone (TME group). The occurrence of TNM downstaging in PRT group was 49.5%, including five percent who had complete response. The local reccurence rate was 4% in PRT group and 8.4% in TME group, with statistically different (p=0.04). An significant improved 5-year overall survival and disease-free survival was obtained in PRT group comparing with TME group (77.2% vs. 69.8%, p=0.04; 76.2% vs. 67.3%, p=0.03). Conclusions: Improved local control and survival benefits could be achieved by short-course preoperative radiotherapy on the basis of standardized TME for locally advanced rectal cancer. No significant financial relationships to disclose.

R406 – Treatment of Squamous Cell Carcinoma of the Hypopharynx

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P179-P179
Author(s):  
Helma Maria Chedid ◽  
Carlos Neutzling Lehn
Keyword(s):  
Overall Survival ◽  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Postoperative Radiotherapy ◽  
Clinical Stage ◽  
Disease Free Survival ◽  
Developed Countries ◽  
Free Survival ◽  
Disease Free

Problem Squamous cell carcinoma of the hypopharynx has been diagnosed at a late stage, including in developed countries, thus denoting worse prognosis. An association between surgery and radiotherapy is the standard treatment for advanced clinical stages. Our aim was to assess the clinical and treatment factors of tumors of the hypopharynx that were treated surgically and with postoperative radiotherapy. Methods This was a retrospective study on 174 patients, among whom two patients were in clinical stage (CS) I, four in CS II, 46 in CS III, and 122 in CS IV. Among these, 222 neck dissections were performed, of which 48 were bilateral. Statistic analysis: Kaplan-Meier methods. Results The mean follow-up was 31 months, and histological examinations showed that two patients were pT1, 15 pT2, 100 pT3 and 57 pT4. With regard to lymph nodes, 25 patients were pN0 and 149 patients were pN+. The disease-free survival in CS III was 75%, versus 28% in CS IV (p=0.001). The disease-free survival was 35% and the overall survival was 28%. Conclusion Surgical treatment for tumors of the hypopharynx occurred in advanced CS, with disease-free survival of 35%. Significance The overall survival and disease free-survival among patients with squamous cell carcinoma of the hypopharynx undergoing surgery.

Perioperative Blood Transfusions are Associated with Worse Overall Survival but not Disease-Free Survival After Curative Rectal Cancer Resection

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
David N. Hanna ◽  
Adriana C. Gamboa ◽  
Glen C. Balch ◽  
Scott E. Regenbogen ◽  
Jennifer M. Holder-Murray ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Overall Survival ◽  
Disease Free Survival ◽  
Blood Transfusions ◽  
Free Survival ◽  
Cancer Resection ◽  
Rectal Cancer Resection ◽  
Disease Free

scholarly journals Three-year outcome after transanal versus laparoscopic total mesorectal excision in locally advanced rectal cancer: a multicenter comparative analysis

2020 ◽  
Author(s):  
F. Borja de Lacy ◽  
Sapho X. Roodbeen ◽  
Jose Ríos ◽  
Jacqueline van Laarhoven ◽  
Ana Otero-Piñeiro ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Locoregional Recurrence ◽  
Locally Advanced ◽  
Survival Rates ◽  
Disease Free Survival ◽  
Advanced Rectal Cancer ◽  
Mesorectal Excision ◽  
Free Survival ◽  
Disease Free

Abstract Background For patients with mid and distal rectal cancer, robust evidence on long-term outcome and causal treatment effects of transanal total mesorectal excision (TaTME) is lacking. This multicentre retrospective cohort study aimed to assess whether TaTME reduces locoregional recurrence rate compared to laparoscopic total mesorectal excision (LapTME). Methods Consecutive patients with rectal cancer within 12 centimetres from the anal verge and clinical stage II-III were selected from three institutional databases. Outcome after TaTME (Nov 2011 - Feb 2018) was compared to a historical cohort of patients treated with LapTME (Jan 2000 - Feb 2018) using the inverse probability of treatment weights method. The primary endpoint was three-year locoregional recurrence. Results A total of 710 patients were analysed, 344 in the TaTME group and 366 in the LapTME group. At three years, cumulative locoregional recurrence rates were 3.6% (95% CI, 1.1–6.1) in the TaTME group and 9.6% (95% CI, 6.5–12.7) in the LapTME group (HR = 0.4; 95% CI, 0.23–0.69; p = 0.001). Three-year cumulative disease-free survival rates were 74.3% (95% CI, 68.8–79.8) and 68.6% (95% CI, 63.7–73.5) (HR = 0.82; 95% CI, 0.65–1.02; p = 0.078) and three-year overall survival 87.2% (95% CI, 82.7–91.7) and 82.2% (95% CI, 78.0-86.2) (HR = 0.74; 95% CI, 0.53–1.03; p = 0.077), respectively. In patients who underwent sphincter preservation procedures, TaTME was associated with a significantly better disease-free survival (HR = 0.78; 95% CI, 0.62–0.98; p = 0.033). Conclusions These findings suggest that TaTME may improve locoregional recurrence and disease-free survival rates among patients with mid and distal locally advanced rectal cancer.

Impact on overall survival and disease-free survival of adjuvant chemotherapy after neoadjuvant chemoradiotherapy for rectal cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14173-e14173
Author(s):  
Rafael amaral de Castro ◽  
Carlos Eduardo Paiva ◽  
Rogerio Saad-Hossne ◽  
Odair Carlito Michelin ◽  
Cristiano de padua Souza
Keyword(s):  
Rectal Cancer ◽  
Overall Survival ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Treatment ◽  
Neoadjuvant Chemoradiotherapy ◽  
Disease Free Survival ◽  
Free Survival ◽  
Group 2 ◽  
Disease Free ◽  
Group 1

e14173 Background: Colorectal cancer is the second most common cancer with 2,4 million people diagnosed. The rectal cancer (RC) is 27% of these cases. Neoadjuvant chemoradiotherapy (NCRT) has become standard but brought controversy in the adjuvant treatment. The objective was to assess the impact of adjuvant chemotherapy after NCRT. Methods: Between mar/96 and Oct/2010, 84 patients received NCRT, and 58 patients underwent resection of the rectum. The NCRT consisted of 5-FU 350mg/m2, D1-D5 (50% of cases) or 5-FU 425mg/m2, D1-D3 (43%) with LV 20mg/m2 bolus in the 1st and 5th week of the 25 sessions of radiotherapy in linear accelerator (total 45 - 50 Gy). When performed, Adjuvant chemotherapy (ADJC) consisted of 5-FU 425mg/m2, LV 20mg/m2, both on D1-D5 for 4 cycles. Evaluation of Overall Survival (O.S) and Disease-Free Survival (DFS) performed using Kaplan-Meier curve in SPSS version 13.0 Results: Of the 58 patients who underwent surgery, 90% were stage II, 51% occurred in the lower rectum and 66% were ECOG 1. Pathologic Complete Response (PCR) was obtained in 25.8% (15) of patients (group 1). Of these, 20% (3) received ADJC. Patients without PCR (group 2) received ADJC in 51% of the cases (22). The mean follow-up was 41 months. Both the DFS (HR: 2.594, 95% CI: 1134-5938, p = 0.024) and OS (HR: 2.615, 95% CI: 1005-6807, p = 0.0488) were higher in patients with PCR independent of the use of ADJC. On the other hand, patient treated with ADJC vs without ADJC, independent of presence of PCR, did not alter DFS (p = 0.74) or OS (p = 0.32). In PCR patients, ADJC do not interfere in the outcome (DFS, p = 0.76; SG, p = 0.73). In group 2 (patients without PCR), the subgroup with ADJC, there was a trend towards better SLD (p = 0.06) and OS (p = 0.06). Those who did not receive ADJC in group 2 had worse SLD (p = 0.011) and OS (p = 0.028) compared with group-1. Conclusions: Adjuvant treatment after NCRT did not increase OS or DFS. Patients without PRC had worse results without ADJC, compared to those with PCR. The first, probably, the subgroup of patients who benefited most from the use of ADJC. PCR improves OS and DFS regardless of ADJC, being perhaps the group that does not deserve ADJC.

Neoadjuvant chemoradiation for rectal cancer: A 5-year institutional experience at Sparrow Hospital

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 14601-14601
Author(s):  
G. Srkalovic ◽  
R. A. Miranda ◽  
M. Maier ◽  
L. DiCarlo ◽  
U. Chamarthy ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Overall Survival ◽  
Rectal Carcinoma ◽  
Proportional Hazards ◽  
Disease Free Survival ◽  
Neoadjuvant Chemoradiation ◽  
Cox Proportional Hazards ◽  
Preoperative Chemoradiation ◽  
Free Survival ◽  
Disease Free

14601 Continued efforts to improve local control and to maximize sphincter preservation in patients with rectal carcinoma led to consideration of preoperative chemoradiation. The purpose of this retrospective study is to examine clinical outcomes and find out which prognostic factors are related to survival in patients treated with neoadjuvant chemoradiation in Sparrow Hospital from 1998–2003. Forty two patients with biopsy proven rectal carcinoma without evidence of extra pelvic spread were treated in this fashion. Radiation therapy was administered for a total dose of 5.00 cGy. Chemotherapy used was 5-FU in 37 patients, and in combination with leucovorin in additional 5 patients. Surgical treatments performed were abdominoperineal resection (23 pts), low anterior resection in 13 pts., transanal excisions (2 pts), 2 patients had only exploratory laparotomy and for 2 patients records were not available. Cox proportional hazards regression techniques were used to estimate survival rates. Univariate and multivariate Cox proportional hazards analyses were used to evaluate relationship between risk factors and the survival. The SAS system (V9.1.3, Cary NC) was used for all analyses. Out of 42 patients analyzed 25 were males and 17 females. Mean age was 65 years (range 31 - 85). Median follow-up time was 57 months with a range from 7 to 98 months. After the surgery 4 patients had complete response, 12 were stage I, 10 stage II, 12 patients stage III, one patient had metastatic disease and for 2 patients records were inadequate. Analysis of disease free survival showed actuarial 5-year disease free survival to be 59%. Actuarial 5-year overall survival was 67%. Median overall survival was still not reached, while median disease-free survival is 78 months . Univariate and multivariate analyses showed that only postoperative stage was associated significantly with overall survival. Specifically, there was an increase in the risk of mortality of just over 3-fold for each increment in post-operative stage. In conclusion, in the community settings preoperative chemoradiation seem to provide good overall and disease free survival for patients with rectal cancer. Postoperative stage appears to be the most important prognostic factor for the survival. No significant financial relationships to disclose.

Randomized Trial of Postoperative Adjuvant Therapy in Stage II and III Rectal Cancer to Define the Optimal Sequence of Chemotherapy and Radiotherapy: A Preliminary Report

2002 ◽  
Vol 20 (7) ◽  
pp. 1751-1758 ◽  
Author(s):  
Jung-Hee Lee ◽  
Je-Hwan Lee ◽  
Jin-Hee Ahn ◽  
Hyeseung Bahng ◽  
Tae-Won Kim ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Randomized Trial ◽  
Group Treatment ◽  
Disease Free Survival ◽  
Stage Ii ◽  
Chemotherapy Cycle ◽  
Optimal Sequence ◽  
Free Survival ◽  
Radiotherapy Group ◽  
Disease Free

PURPOSE: We conducted a prospective randomized trial to define the optimal sequence of chemotherapy and radiotherapy of postoperative adjuvant treatment in stage II and III rectal cancer. PATIENTS AND METHODS: Three hundred eight patients were enrolled onto the study. We randomly assigned 155 to arm I (early radiotherapy group) and 153 to arm II (late radiotherapy group). Treatment included eight cycles of chemotherapy at 4-week intervals and pelvic radiotherapy of 45 Gy in 25 fractions. Radiotherapy started on day 1 of the first chemotherapy cycle in arm I and on day 1 of the third chemotherapy cycle in arm II. The chemotherapy regimen consisted of fluorouracil 375 mg/m2/d and leucovorin 20 mg/m2/d. Chemotherapy was administered for 3 days per cycle in two cycles during the period of radiotherapy and for 5 days per cycle in the remaining six cycles. RESULTS: Twenty patients in arm I and 14 in arm II were not eligible. We included 274 patients in the analysis. With a median follow-up of 37 months for surviving patients, disease-free survival was significantly prolonged in arm I compared with arm II (81% v 70% at 4 years; P = .043). Twenty-three recurrences occurred in arm I and 38 in arm II (P = .047). Overall survival was not significantly different between arms I and II (84% v 82% at 4 years; P = .387). CONCLUSION: Early radiotherapy with concurrent chemotherapy after resection of stage II and III rectal cancer demonstrated a statistically significant advantage for disease-free survival compared with late radiotherapy with chemotherapy.

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