Optimal fractionation of preoperative radiotherapy and timing to surgery for rectal cancer (Stockholm III): a multicentre, randomised, non-blinded, phase 3, non-inferiority trial

Erlandsson, Johan; Holm, Torbjörn; Pettersson, David; Berglund, Åke; Cedermark, Björn; Radu, Calin; Johansson, Hemming; Machado, Mikael; Hjern, Fredrik; Hallböök, Olof; Syk, Ingvar; Glimelius, Bengt; Martling, Anna

doi:10.1016/s1470-2045(17)30086-4

Cited by 508 publications

(354 citation statements)

References 31 publications

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“…A recent randomized prospective study confirmed those findings by demonstrating that preoperative long-course radiotherapy alone, coupled with delayed conventional surgery, and preoperative short-course radiotherapy, coupled with immediate (within 1 week) or delayed (within 4-8 weeks) surgery, are noninferior in terms of local and distant recurrence, os, and postoperative complications 42 . Furthermore, patients treated with short-course radiation and delayed surgery experienced a significantly higher rate of pathologic complete response 43 .…”

Section: Evidence Summarymentioning

confidence: 73%

Eastern Canadian Colorectal Cancer Consensus Conference 2017

et al. 2018

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The annual Eastern Canadian Gastrointestinal Cancer Consensus Conference 2017 was held in St. John's, Newfoundland and Labrador, 28-30 September. Experts in radiation oncology, medical oncology, surgical oncology, and cancer genetics who are involved in the management of patients with gastrointestinal malignancies participated in presentations and discussion sessions for the purpose of developing the recommendations presented here. This consensus statement addresses multiple topics in the management of gastric, rectal, and colon cancer, including ■ identification and management of hereditary gastric and colorectal cancer (crc); ■ palliative systemic therapy for metastatic gastric cancer; ■ optimum duration of preoperative radiation in rectal cancer-that is, short-compared with long-course radiation; ■ management options for peritoneal carcinomatosis in crc; ■ implications of tumour location for treatment and prognosis in crc; and ■ new molecular markers in crc.

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Section: Evidence Summarymentioning

confidence: 73%

Eastern Canadian Colorectal Cancer Consensus Conference 2017

et al. 2018

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“…However, no significant differences in local recurrence, distant recurrence, or survival were observed. Postoperative complications (38%‐50%), surgical complications (23%‐31%), and reoperation (7%‐11%) were also not different among treatment arms …”

Section: Discussionmentioning

confidence: 90%

Improved survival in rectal cancer patients who are treated with long‐course versus short‐course neoadjuvant radiotherapy: A propensity‐matched analysis of the NCDB

Chapman

Goodman

Hosokawa

et al. 2019

Journal of Surgical Oncology

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Background Randomized controlled trials have demonstrated comparable survival outcomes for short‐course (SCRT) and long‐course neoadjuvant radiotherapy (LCRT) in patients with rectal cancer. Methods Using the National Cancer Data Base (2004‐2015), a propensity score was used to match 188 patients with rectal cancer receiving SCRT to 376 patients receiving LCRT. Perioperative, oncologic, and survival outcomes were compared. Results Patient and clinical tumor characteristics were similar between groups. Patients in the LCRT were more likely to undergo surgery (91% vs 85%; P = 0.03). The LCRT group were more likely to have tumor (T) (56% vs 43%) and nodal (N) (25% vs 19%) downstaging, and a complete pathological response (15% vs 6%) compared with the SCRT group (all P < 0.05). Length of stay (6 vs 8 days), 30‐day (1% vs 5%) mortality, and 90‐day mortality (1% vs 10%) were significantly lower in the LCRT group (all P < 0.05). After adjusting for patient and tumor‐related characteristics, LCRT was associated with a 50% reduction in the risk of mortality compared with SCRT (hazard ratios, 0.50; 95% confidence interval, 0.35‐0.70). Conclusions In this analysis, LCRT was superior to SCRT in terms of tumor response to neoadjuvant therapy, perioperative mortality, and overall survival. These findings provide evidence for the use of LCRT when neoadjuvant therapy is indicated.

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“…After initial non-randomized studies reported more down-staging and pCR in comparison to SCRT with early surgery 17, 18 , Stockholm III compared SCRT with immediate surgery, SCRT with delayed surgery, and LCRT in a randomized trial of 840 patients with resectable rectal cancer 19, 20 . In comparison to SCRT with immediate surgery, SCRT with delayed surgery was associated with fewer post-operative complications and higher rates of tumour down-staging, tumour regression and pCR (11.8% vs. 1.7%).…”

Section: Short-course Radiation For Ct3/4 Larcmentioning

confidence: 99%

Selective use of radiation for locally advanced rectal cancer: one size does not fit all

Roxburgh

Weiser

2018

Minerva Chir

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INTRODUCTION The last three decades have seen several major advances in the multidisciplinary management of locally advanced rectal cancer (LARC). Although rectal cancer management varies globally, the standard of care for clinical stage II/III rectal cancer in North America remains chemoradiation followed by total mesorectal excision and adjuvant therapy. EVIDENCE ACQUISITION In this review we evaluate the evidence for neoadjuvant therapy in LARC and the variety of treatment options available. EVIDENCE SYNTHESIS We identify heterogeneity of outcomes in stage II/III rectal cancer, leading to the potential for overtreatment. The PROSPECT trial is a multi-centre, international effort to determine whether a selective approach to provision of radiotherapy in stage II/ III LARC is a viable treatment option. Unlike many other studies, the aim of PROSPECT is to reduce treatment rather than increase the intensity of preoperative therapy. CONCLUSION LARC is a heterogeneous disease with varying risk of relapse. Studies are underway to attempt to individualise care to avoid overtreatment while maintaining excellent oncologic outcomes.

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Optimal fractionation of preoperative radiotherapy and timing to surgery for rectal cancer (Stockholm III): a multicentre, randomised, non-blinded, phase 3, non-inferiority trial

Cited by 508 publications

References 31 publications

Eastern Canadian Colorectal Cancer Consensus Conference 2017

Eastern Canadian Colorectal Cancer Consensus Conference 2017

Improved survival in rectal cancer patients who are treated with long‐course versus short‐course neoadjuvant radiotherapy: A propensity‐matched analysis of the NCDB

Selective use of radiation for locally advanced rectal cancer: one size does not fit all

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