Improved local control of rectal cancer reduces distant metastases

Bernstein, T. E.; Endreseth, Birger Henning; Romundstad, Pål Richard; Wibe, Arne

doi:10.1111/j.1463-1318.2012.03089.x

Cited by 43 publications

(29 citation statements)

References 24 publications

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“…First, the method of identifying patients with threatened or involved mesorectal margins has never been subjected formally to reliability or validity testing. However, the methods are similar to those used in two other papers that also made recommendations for preoperative irradiation based on mesorectal margin status 16,17 . A second potential limitation was the use of CT versus MRI to predict the status of mesorectal margins.…”

Section: Discussionmentioning

confidence: 74%

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Outcomes following a limited approach to radiotherapy in rectal cancer

Šimunović

Jacob

Coates

et al. 2011

British Journal of Surgery

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Section: Discussionmentioning

confidence: 74%

“…Many European centres support the use of preoperative short-course radiation therapy (delivered over 1 week) for nearly all patients 4 -6 . An exception is Norway, where radiation is rarely used 16 . These major variations around the world suggest a need for a more rational approach in an era of standardized surgery.…”

Section: Introductionmentioning

confidence: 99%

Outcomes following a limited approach to radiotherapy in rectal cancer

Šimunović

Jacob

Coates

et al. 2011

British Journal of Surgery

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“…12 An involved CRM is an independent disease prognostic indicator. 13 It is defined pathologically as identifying tumour cells within 1 mm of the surgically created margin. Beets-Tan et al 14 postulated that, on MRI, a distance of 6 mm from the outer edge of the tumour to the mesorectal fascia predicted a tumour distance of 2 mm on histology with 97% confidence, and a distance of 5 mm could predict a crucial distance of 1 mm on histology with high confidence.…”

Section: Discussionmentioning

confidence: 99%

Limitation of radiological T3 subclassification of rectal cancer due to paucity of mesorectal fat in Chinese patients

et al. 2014

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Objectives:To describe the thickness of mesorectal fat in local Chinese population and its impact on rectal cancer staging.Design: Case series.Setting: Two local regional hospitals in Hong Kong.Patients: Consecutive patients referred for multidisciplinary board meetings from January to October 2012 were selected. Main outcome measures:Reports of cases that had undergone staging magnetic resonance imaging for histologically proven rectal cancer were retrospectively retrieved and reviewed by two radiologists. All magnetic resonance imaging examinations were acquired with 1.5T magnetic resonance imaging. Measurements were made by agreement between the two radiologists. The distance in mm was obtained in the axial plane at levels of 5 cm, 7.5 cm, and 10 cm from the anal verge. Four readings were obtained at each level, namely, anterior, left lateral, posterior, and right lateral positions.Results: A total of 25 patients (16 males, 9 females) with a median age of 69 (range, 38-84) years were included in the study. Mean thickness of the mesorectal fat at 5 cm, 7.5 cm, and 10 cm from the anal verge was 3.1 mm (standard deviation, 3.0 mm), 9.8 mm (5.3 mm), and 11.8 mm (4.2 mm), respectively. The proportions of patients with mean Limitation of radiological T3 subclassification of rectal cancer due to paucity of mesorectal fat in Chinese patients

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“…With a median follow up of 43 months, they reported a 6% local recurrence rate at 5 years for patients undergoing anterior resection (with a median level of tumour at 8 cm from the anal verge). Recent population-based data [34] and retrospective series exploiting these advances further undermine the approach of a blanket use of radiotherapy/chemoradiation by exploring the omission of radiotherapy when MRI suggests the tumour is easily resectable and the circumferential resection margin (CRM) is not threatened [35–38]. Others have also recently questioned the routine use of chemoradiation for rectal cancer [39,40].…”

Section: Rectal Cancer: Neoadjuvant Therapy Before Surgical Treatmentmentioning

confidence: 99%

Neoadjuvant therapy before surgical treatment

Glynne‐Jones

Chau

2013

European Journal of Cancer Supplements

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Neoadjuvant treatment in terms of preoperative radiotherapy reduces local recurrence in rectal cancer, but this improvement has little if any impact on overall survival. Currently performed optimal quality-controlled total mesorectal excision (TME) surgery for patients in the trial setting can be associated with very low local recurrence rates of less than 10% whether the patients receive radiotherapy or not. Hence metastatic disease is now the predominant issue. The concept of neoadjuvant chemotherapy (NACT) is a potentially attractive additional or alternative strategy to radiotherapy to deal with metastases. However, randomised phase III trials, evaluating the addition of oxaliplatin at low doses plus preoperative fluoropyrimidine-based chemoradiotherapy (CRT), have in the main failed to show a significant improvement on early pathological response, with the exception of the German CAO/ARO/AIO-04 study. The integration of biologically targeted agents into preoperative CRT has also not fulfilled expectations. The addition of cetuximab appears to achieve relatively low rates of pathological complete responses, and the addition of bevacizumab has raised concerns for excess surgical morbidity. As an alternative to concurrent chemoradiation (which delivers only 5–6 weeks of chemotherapy), potential options include an induction component of 6–12 weeks of NACT prior to radiotherapy or chemoradiation, or the addition of chemotherapy after short-course preoperative radiotherapy (SCPRT) or chemoradiation (defined as consolidation chemotherapy) which utilises the “dead space” of the interval between the end of chemoradiation and surgery, or delivering chemotherapy alone without any radiotherapy.

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Improved local control of rectal cancer reduces distant metastases

Abstract: Improved diagnostics and treatment of rectal cancer aiming at better local control and survival have resulted in a significant reduction in the incidence of distant metastases.

Cited by 43 publications

References 24 publications

Outcomes following a limited approach to radiotherapy in rectal cancer

Outcomes following a limited approach to radiotherapy in rectal cancer

Limitation of radiological T3 subclassification of rectal cancer due to paucity of mesorectal fat in Chinese patients

Neoadjuvant therapy before surgical treatment

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