Effect of preoperative irradiation on resectability of colorectal carcinomas

Irinotecan+5-fluorouracil with concomitant pre-operative radiotherapy in locally advanced non-resectable rectal cancer: a phase I/II study

“…Furthermore, the resection rate achieved in this study is higher than that observed in studies using radiotherapy alone (range, 64 -75%) (Emami et al, 1982;Frykholm et al, 2001) or in some studies of CRT regimens (62 -95%) (de la Torre et al, 1999;Frykholm et al, 2001;Klautke et al, 2006;Glynne-Jones et al, 2007), and it is comparable to that cited in other reports of research with irinotecan (90 -100%) (Minsky et al, 1999;Mitchell et al, 2004;Klautke et al, 2005;Sebag-Montefiore et al, 2005). It is worth noting, that this current trial included only patients with T3/T4 cancers-that is patients with more advanced disease than those included in previously published studies.…”

“…Considering CRM involvement, 81% of patients in this study who underwent TME surgery were classed as R 0 after surgery (CRM-negative). In studies that report data on the number of CRM-negative cases, results range from 61 -74% with radiotherapy (Emami et al, 1982;Frykholm et al, 2001) to 72 -89% with 5-FUbased protocols (de la Torre et al, 1999;Frykholm et al, 2001;Avallone et al, 2006;Klautke et al, 2006;Glynne-Jones et al, 2007) or 88 -89% when irinotecan is given as part of the CRT regimen (Klautke et al, 2005;Sebag-Montefiore et al, 2005). The addition of irinotecan to CRT regimens does not, therefore, seem to increase the high rate of CRM-negative surgery reported previously, but CRT certainly seems to be more successful than radiotherapy alone.…”

Exenterative pelvic surgery

“…An extensive deliberation of this subject is beyond the scope of this review. However, preoperative radiotherapy re- portedly converts to resectability some rectosigmoid carcinomas that were originally deemed unresectable, usually because of fixation to the pelvic wall [57][58][59]. With evidence of down-staging by radiotherapy, now used more frequently in conjunction with chemotherapy, patients with locally advanced rectosigmoid carcinoma should be considered for preoperative treatment with this adjuvant.…”

Locally Advanced Rectal Cancer: What Is the Evidence for Induction Chemoradiation?

“…Preoperative RT without chemotherapy for such locally advanced tumors using doses of 45-50 Gy was reported [25] to be capable of downstaging 79% of patients, which resulted in high resection rates being achieved. This assessment was based on digital rectal examination and fixity, and lacks the accuracy of MRI scanning.…”

“…Despite complete resection, the 5-year survival rate was only 18%, and these patients continued to have a high risk for local failure. Patients who remain unresectable after RT have an even poorer overall median survival duration of only 8 -10 months [25,26].…”