Neoadjuvant chemoradiotherapy for locally advanced rectal cancer: The debate continues

Abstract

Rectal carcinoma represents the 30% of all colorectal cancers, with about 40000 new cases/years. In the past two decades, the management of rectal cancer has made important progress, highlighting the main role of a multimodality strategy approach, combining surgery, radiation therapy and chemotherapy. Nowadays, surgery remains the primary treatment and neoadjuvant chemoradiotherapy, based on fluoropyrimidine (5-FU) continuous infusion, is considered the standard in locally advanced rectal carcinoma. The aim is to reduce the incidence of local recurrence and to perform a conservative surgery. To improve these purposes different drugs combination have been tested in the neo-adjuvant setting. At American Society of Clinical Oncology 2014 an important abstract was presented focusing on the role of adding oxaliplatin to concomitant treatment, in patients with locally advanced rectal carcinoma. Rodel et al reported on the CAO/ARO/AIO-04 randomized phase Ⅲ trial that compared standard treatment with 5-FU and radiation therapy, to oxaliplatin plus 5-FU in association with radiation therapy. The addition of oxaliplatin to the neo-adjuvant treatment has been shown to improve disease-free survival from 71.2% to 75.9% (P = 0.03). This editorial was planned to clarify the optimal treatment in patients with locally advanced rectal cancer, considering the results from CAO/ARO/AIO-04 study. De Felice F, Musio D, Izzo L, Tombolini V. Neoadjuvant chemoradiotherapy for locally advanced rectal cancer: The debate continues.

Efficacy of Neo-Adjuvant Chemoradiotherapy for Resectable Pancreatic Adenocarcinoma

“…A total of 171 studies were identified in the database searches, and 10 full text articles were reviewed after exclusion of 161 for not meeting the inclusion/exclusion criteria. Two studies were subsequently excluded on the basis of being a review 4 or a protocol. 18 Eight studies were included in the final meta-analysis.…”

“… 3 Thus, interest has grown in neo-adjuvant (preoperative) therapy for pancreatic cancer. In advanced rectal cancer, neo-adjuvant therapy is considered the standard of care, 4 and neo-adjuvant therapy in patients with resectable pancreatic cancer has yielded some encouraging results. 5 – 11 The proposed benefits of chemoradiotherapy (CRT) in pancreatic cancer are control of local disease and the improved rate of complete resection.…”

Clinical predictive factors of pathologic complete response in locally advanced rectal cancer

“…Radiotherapy (RT) was delivered with a 3D-conformational multiple field technique at a dose of 45 Gy (1,8 Gy/fraction) to the whole pelvis plus a 5,4–9 Gy (1,8 Gy/fraction) to the tumor volume. Chemotherapy (CHT) consisted of weekly OXP (50 mg/m 2 , day 1) and five daily continuous infusions of 5-FU (200 mg/m 2 /day) of each week of RT, based on promising results in high rate of pCR [7–8]. Surgery was planned 7–9 weeks after the end of nCRT and its type was left to surgeon's discretion.…”

Colorectal cancer in the elderly patient: the role of neo-adjuvant therapy

“…Neoadjuvant therapy has also led to the increase of number of conservative interventions, as well as improving the prognosis by reducing the incidence of recurrence and increasing survival [1, 2, 3, 4, 5, 6]. On the other hand surgery alone has a high rate of complications (10-65%) and local recurrence (10-29%) [7].…”