A favourable pathological stage after neoadjuvant radiochemotherapy in patients with initially irresectable rectal cancer correlates with a favourable prognosis

Reerink, O.; Verschueren, Rcj; Szabo, Bernard; Hospers, Geke A.P.; Mulder, Nanno

doi:10.1016/s0959-8049(02)00557-9

Cited by 55 publications

(31 citation statements)

References 25 publications

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“…Three patients (8%) have had evidence of microscopic residual disease (R1), two patients have refused surgery with a radiological complete response (5%) and four patients had progressive disease (11%). This is similar to the published data [8,20,21].…”

Section: Resultssupporting

confidence: 93%

“…This technique has been clearly demonstrated to improve local recurrence rate and 5 year survival [22][23][24]. However, recent studies of more than 1000 patients even with optimal surgical technique have reported CRM involvement rates of between 6.7% and 7.5% after anterior resection and between 16.7% and 17.6% for low rectal cancers requiring abdominoperineal excision (APER) [8,23]. The evidence base for radiotherapy in operable rectal cancer is discussed at length by Craven and Sebag-Montefiore [25].…”

Section: Discussionmentioning

confidence: 99%

“…This knowledge together with our current understanding of where rectal cancer recurs following TME and radiotherapy [7,8] suggests that standard treatment planning by the use of traditional bony landmarks is now likely to be inadequate. Furthermore, clinical data indicate that the larger the volume of small bowel irradiated the higher the risk of acute and late toxicity [9][10][11][12].…”

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confidence: 99%

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Comparison of conventional and three-dimensional conformal CT planning techniques for preoperative chemoradiotherapy for locally advanced rectal cancer

Corner

Khimji²,

Tsang³

et al. 2011

BJR

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Objectives:We assessed the impact of three-dimensional (3D) conformal planning vs conventional planning of preoperative chemoradiotherapy (CRT) for locally advanced rectal cancer (LARC) on small bowel and bladder sparing and in optimising coverage of tumour target volume. Methods: Conformal and conventional plans were created for 50 consecutive patients. The conformal plan delineated a gross tumour volume (GTV), a clinical target volume (CTV) 1 to cover potential subclinical disease spread, a CTV2 to outline the mesorectum and lymph node areas at risk, and a planning target volume (PTV) to cover set-up error and organ movement. The conventional plan was created using digitally reconstructed radiographs (DRRs). Patients were treated with a dose of 45 Gy in 25 fractions with concurrent chemotherapy over 5 weeks. Dose-volume histograms (DVHs) were created and compared for GTV, PTV, small bowel and bladder. The GTV was covered by the conventional plan in all patients. Results: Significant differences were shown for median PTV coverage with conformal planning compared with conventional planning: 99.2% vs 94.2% (range 95.9-100% vs 75.5-100%); p,0.05. The median volume of irradiated small bowel was significantly lower for CT plans at all DVH levels. Median bladder doses did not differ significantly. Conclusion: 3D conformal CT planning is superior to conventional planning in terms of coverage of the tumour volume. It significantly reduces the volume of small bowel irradiated with no decrease in the rate of R0 resection compared with published data, and at the present time should be considered as the standard of care for rectal cancer planning. Chemoradiotherapy (CRT) followed by total mesorectal excision is the standard for care when MRI staging demonstrates threatened surgical margins in locally advanced rectal cancer (LARC) [1,2]. Radiotherapy planning for rectal cancer uses conventional orthogonal simulation with standardised radiation fields based on patterns of loco-regional relapse in relation to pelvic bony anatomy [3]. Three-field conventional orthogonal planning is considered an acceptable technique for planning preoperative CRT and major trials evaluating long-course chemoradiation for rectal cancer have permitted the use of conventional planning within their protocols [4,5]. In recent years, the treatment of rectal cancer has improved through advances in the planning and delivery of radiotherapy as well as improved preoperative imaging with MRI, the development of surgical techniques using total mesorectal excision (TME) and more accurate histopathological reporting [6]. Radiotherapy planning must ensure all clinically and radiologically identifiable disease is encompassed while still minimising the dose to the surrounding organs at risk, particularly the small bowel and bladder. Potential areas of microscopic spread and the appropriate pelvic lymph nodes should also be treated.Preoperative MRI has improved the knowledge of pelvic anatomy and identification of pelvic lymph nodes at risk according to tumour l...

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Section: Resultssupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Comparison of conventional and three-dimensional conformal CT planning techniques for preoperative chemoradiotherapy for locally advanced rectal cancer

Corner

Khimji²,

Tsang³

et al. 2011

BJR

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“…Radiotherapy or chemoradiation has been widely used to improve patient outcomes in locally advanced rectal cancer (LARC), 5-FUbased chemoradiation is an effective treatment, shown by many phase II studies (Chen et al, 1994;Kaminsky-Forrett et al, 1998;Janjan et al, 1999;Crane et al, 2003). Preoperative chemoradiation increases the resection rate (Reerink et al, 2003) and preoperative radiation or chemoradiotherapy decrease local recurrence and reduce small bowel complications compared with postoperative therapy (Minsky et al, 1992;Frykholm et al, 1993, Sauer et al, 2004. R0 resection rates of 60 -85% have reported with 5-FUbased preoperative chemoradiation for LARC (Videtic et al, 1998;Küchenmeister et al, 2000;Rödel et al, 2000).…”

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confidence: 99%

Concurrent chemoradiation with capecitabine and weekly irinotecan as preoperative treatment for rectal cancer: results from a phase I/II study

et al. 2006

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The aim of this study was to investigate the efficacy and safety of chemoradiation using capecitabine and irinotecan as neoadjuvant therapy for patients with rectal cancer. Conventional radiation was given at daily fractions of 1.8 Gy on 5 days a week for a total dose of 55.8 (50.4 þ 5.4) Gy. Concurrently, irinotecan 40 mg m À2 once weekly and capecitabine continuously at dose levels of 500, 650, 750 and 825 mg m À2 twice daily were administered. Surgery was performed 4 -6 weeks following completion of chemoradiation. A total of 28 patients (3 UICC II, 25 UICC III) were enrolled and all received treatment. Dose-limiting toxicity was diarrhoea grade IV and hand -foot syndrome at the 825 mg m À2 dose level. The maximum tolerated dose of capecitabine was 750 mg m À2 . Diarrhoea was the most common toxicity: grade III in nine patients. Two patients died, one due to pneumonia and one due to sudden cardiac death. A complete response and only microfocal residual tumour disease was achieved in four and three patients (27%). In all, 25 of 28 patients undergoing surgery, 24 (96%) had R0 resection. Preoperative chemoradiation based on continuous daily capecitabine and weekly irinotecan appears to tolerated and effective in patients with rectal cancer.

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“…The accuracies of N staging for the MRI sets were equal (57%) ( Table 2). The overall accuracy of MR imaging in predicting T staging has been reported from 71%-91% (mean, 85%), and the range of overall accuracy of MR imaging in predicting N staging was 43%-85% (mean, 75%) (15)(16)(17)(18)(19)(20)(21)(22)(23)(24).…”

Section: Resultsmentioning

confidence: 99%

Preoperative Evaluation of Lower Rectal Cancer by Pelvic MR with and without Gel Filling

Kim

Lim

et al. 2014

J Korean Soc Magn Reson Med

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A favourable pathological stage after neoadjuvant radiochemotherapy in patients with initially irresectable rectal cancer correlates with a favourable prognosis

Cited by 55 publications

References 25 publications

Comparison of conventional and three-dimensional conformal CT planning techniques for preoperative chemoradiotherapy for locally advanced rectal cancer

Comparison of conventional and three-dimensional conformal CT planning techniques for preoperative chemoradiotherapy for locally advanced rectal cancer

Concurrent chemoradiation with capecitabine and weekly irinotecan as preoperative treatment for rectal cancer: results from a phase I/II study

Preoperative Evaluation of Lower Rectal Cancer by Pelvic MR with and without Gel Filling

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