Influence of the Interval Between Preoperative Radiation Therapy and Surgery on Downstaging and on the Rate of Sphincter-Sparing Surgery for Rectal Cancer: The Lyon R90-01 Randomized Trial

François, Y.; Némoz, C.; Baulieux, J.; Vignal, J; Grandjean, Jean-Paul; Partensky, Christian; Souquet, J. C.; Adeleine, P.; Gérard, Jean-Pierre

doi:10.1200/jco.1999.17.8.2396

Cited by 744 publications

(500 citation statements)

References 29 publications

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“…However, the surgeons were asked before radiotherapy started whether they could perform an anterior resection. The overall recurrence rate was 9%, and in the group of patients having an anterior resection where a sphincter-preserving operation did not seem possible initially, the local recurrence rate was 12% (57). The numbers were small in this trial, but the data must be taken seriously, and it might be dangerous to rely on the downstaging effect caused by preoperative chemoradiotherapy and change surgery from an abdominoperineal procedure to a sphincter-persevering operation.…”

Section: What Type Of Radiotherapymentioning

confidence: 87%

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Perioperative Radiotherapy in the Management of Rectal Cancer

Påhlman

2001

Canadian Journal of Gastroenterology

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Surgery for rectal cancer has resulted in unacceptably high local failure rates, and substantial morbidity and mortality. In an attempt to reduce the high frequency of local recurrence, perioperative radiotherapy has been used extensively, alone or in combination with chemotherapy. The local recurrence rate has been reduced dramatically with the use of radiotherapy, and provided that the dose is high enough and given preoperatively, the reduction rate has been about 50%. Despite that a higher dose is used in postoperative radiotherapy, the reduced recurrence rate is not that prominent. The reduced recurrence rate demonstrated after preoperative radiotherapy has a positive influence on survival, which has not been seen when radiotherapy is given postoperatively. However, when postoperative irradiation has been combined with chemotherapy, a survival benefit has been demonstrated. With modern radiation techniques, preoperative radiotherapy can be delivered without any substantial increase in postoperative mortality or morbidity, and a low rate of late toxicity, provided that the radiation technique is optimal. The main question is whether radiotherapy is necessary, provided that surgery is optimized. With standard surgery, the average local recurrence rate is 29% in all reported controlled trials. With optimal surgery, from institutional series, this figure is about 10%. Other questions to be answered are whether superfractionated or standard fractionation should be used in radiotherapy and exactly to whom it should be given.

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Section: What Type Of Radiotherapymentioning

confidence: 87%

“…This has been studied in a French trial (57) in which all patients received chemoradiotherapy but were randomly assigned to have surgery immediately after irradiation or after six weeks. More patients had their sphincters preserved if surgery was delayed (76% versus 68%, respectively).…”

Section: What Type Of Radiotherapymentioning

confidence: 99%

Perioperative Radiotherapy in the Management of Rectal Cancer

Påhlman

2001

Canadian Journal of Gastroenterology

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“…The main indications being to downstage the disease and organ preservation & relative hypothesis is to tackle the microscopic disease and assessment of response to treatment [1]. Surgery should be performed after a gap of 4-5 weeks for maximum benefit in terms of response and also minimum toxicity as shown by the Lyon R90-01 a randomized trial [7].…”

Section: Neoadjuvant Treatmentmentioning

confidence: 99%

Principles of Radiation Oncology: A Beams Eye View for a Surgeon

Koushik

Harish

Avinash

2013

Indian J Surg Oncol

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Knowledge about the radiation medicine as a whole has gained importance in the recent past due to better understanding of not only the physical and biological principles but also advancements in the technology and better understanding of oncological principles. This review will try to address some of these aspects that are considered relevant to a surgeon dealing with oncology cases. With recent advancements we are able to achieve a better therapeutic ratio, that is more dose to the tumour and lesser dose to the normal tissues. This review will help the surgeon in understanding the basics and also be aware of the recent advances in radiotherapy.

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“…Furthermore, in patients presenting with a surgically non-resectable tumor, preoperative RT can cause tumor regression allowing subsequent radical surgery in a substantial proportion of patients (34). It has also been suggested that preoperative RT facilitates sphincter-preserving procedures by decreasing the size of the tumor (33,35), however, this was not significant in a Cochrane systematic review (36). Thus, preoperative RT is now considered standard treatment in LARC at least in the European health community (37)(38)(39).…”

Section: Neoadjuvant Radiotherapy (Rt)mentioning

confidence: 99%