Developments in treatment of primary irresectable rectal cancer

Abstract

The treatment options for primary irresectable rectal cancers are discussed. Assessment of tumour stage is the first step for an appropriate choice of treatment. Following a diagnosis of rectal cancer, a vast array of diagnostic procedures is available to determine its stage, and thereby its best treatment options. From the many (new) diagnostic options the merits and drawbacks are discussed. If a diagnosis of irresectability is made, further treatment options should include radiotherapy in most cases, some aspects of timing and application, i.e. intra-operative treatment are discussed. Chemotherapy options are manifold, the results are discussed and some new options are explored.

High-dose radiotherapy and concurrent UFT plus l-leucovorin in locally advanced rectal cancer: A phase I trial

“…In these patients, primary radical resection is seldom possible but it is now clear that a combination of radiotherapy and chemotherapy can produce tumour shrinkage which allows radical surgery in more than 50% of the patients [8]. It may be anticipated that the improved tumour remission translates to survival benefit although this has not been proven in randomized trials.…”

“…Continuous venous infusion of 5-FU (CVI) is the standard regimen in conjunction with radiotherapy in postoperative chemoradiotherapy [14], but the substitution of oral therapy (UFT/Lv or Capecitabine) for CVI is more convenient for patients and probably as effective [13,21]. No study has compared efficacy and toxicity of UFT and capecitabine in combination with radiotherapy but hand-foot syndrome I seen more often in patients receiving capecitabine [8].…”

“…There is no agreed definition of LARC [4,8] but patients were included in the present study if the tumour was fixed and unresectable as judged clinically by an experienced colorectal surgeon. In these patients, primary radical resection is seldom possible but it is now clear that a combination of radiotherapy and chemotherapy can produce tumour shrinkage which allows radical surgery in more than 50% of the patients [8].…”

“…Radiotherapy in a dose of 40 Á/50 Gy in 25 fractions can render a certain fraction of LARC resectable [3,8], and perhaps a higher dose would improve the local control [8 Á/10], although a clear dose-effect relationship has not been proven in radiation treatment of LARC. A higher dose without doubt increases the risk of toxicity, but the higher risk of toxicity may be reduced by modern treatment planning and a technique applying a high dose to the tumour volume only.…”

Long-term results of a phase II trial of high-dose radiotherapy (60 Gy) and UFT/l-leucovorin in patients with non-resectable locally advanced rectal cancer (LARC)

“…Both short-and long-term RT reduce local recurrence rates (LRR) in patients with resectable RC but only long-term RT produces tumour regression and short-term RT can therefore not be used in patients with LARC [13]. Combining radiotherapy and chemotherapy in these patients can produce tumour shrinkage with subsequent radical surgery in more than 50% [14]. Thus, the evidence is only indirect that RCT is superior to RT alone.…”