Low-dose preoperative radiation postpones recurrences in operable rectal cancer: Results of a randomized multicenter trial in western norway

Abstract

A randomized, multicenter clinical trial was conducted in Western Norway to study the effectiveness of preoperative radiation therapy in operable rectal cancer, given at a dosage of 3150 cGy in 18 fractions, 2 to 3 weeks before radical surgery. Three hundred nine patients were entered into the trial between May 1976 and December 1985. After radiation no tumor was seen in 4.5% of the patients. There was no increased morbidity or mortality at surgery. The 5-year survival for evaluable patients was 57.5% in the control group and 56.7% in the radiotherapy group. For patients operated on for cure the 5-year survival was 60.9% and 64.2% in the control group and radiotherapy group, respectively. Radiation significantly delayed both local and distant recurrences in patients in the radiation group who had curative resection from 13.3 months in controls to 27.1 months. The local recurrence rate in the corresponding groups was 21.1% and 13.7%, respectively. We conclude that higher preoperative radiation doses should be used in new trials as a higher dosage may transform the observed positive effects into a survival benefit.

Importance of tumor regression assessment in predicting the outcome in patients with locally advanced rectal carcinoma who are treated with preoperative radiotherapy

“…Moreover, our method of lymph node dissection by clearing mesorectal fat significantly facilitated the detection of lymph node metastases. In the literature data, a reduced number of lymph node metastases after preoperative radiotherapy was reported in some studies 8,16,18,38,42,44 whereas in other studies no significant difference was found. 12,17,32 …”

“…In contrast to some studies, we did not observe a single case of complete tumor regression in patients with rectal carcinoma after preoperative radiotherapy. 7,30,38 This might be explained by the short delay between the end of the radiotherapy and surgery in the schedule used in the current study and also by the fact that only patients with locally advanced stages of rectal carcinoma were included in the current study compared with other studies in which a significant proportion of patients with cT1-T2 tumors was included. 30 To our knowledge, there have been no reports to date of complete tumor regression occurring when surgery is performed within 1 week after the end of radiotherapy, a finding that is consistent with our own data.…”

Integration of Epidermal Growth Factor Receptor Inhibitors with Preoperative Chemoradiation

“…Therefore, radiotherapy alone or in combination with chemotherapy is used prior to surgery to reduce the tumor size. Extensive studies on the use of (chemo) radiotherapy for these tumors showed that preoperative radiotherapy decreases local recurrence rates by 50 to 60% as compared with surgery alone (43)(44)(45)(46)(47)(48)(49), and the addition of chemotherapy to radiotherapy has been shown to further increase local control (50)(51)(52)(53)(54). On the basis of these results, the current standard treatment of locally advanced rectal cancer consists of preoperative chemoradiation followed by total mesorectal excision surgery.…”

Time to loco-regional recurrence after resection of Dukes' B and C colorectal cancer with or without adjuvant postoperative radiotherapy. A multivariate regression analysis

“…Although several trials, historically controlled or randomised (see the review by Cohen et al, 1989 andDahl et al, 1990), have found an improved local control after combined surgery and radiotherapy the actual importance, if any, of the sequence of the two treatment modalities remains to be investigated. Furthermore, in most of these trials the improvement in local control after preoperative radiotherpy did not result in any significant improvement in survival (Mayer et al, 1989;Cohen et al, 1989).…”