Postoperative radiation and concomitant bolus fluorouracil with or without additional chemotherapy with fluorouracil and high-dose leucovorin in patients with high-risk rectal cancer: A randomized phase III study conducted by the Hellenic Cooperative Oncology Group

Fountzilas, George; Zisiadis, A.; Dafni, Urania; Konstantaras, Christos; Hatzitheoharis, George; Liaros, Angela; Athanassiou, E.; Dombros, Nikolaos; Dervenis, Christos; Basdanis, G.; Gamvros, O.; Souparis, A.; Briasoulis, Evangelos; Samantas, E.; Kappas, Angelos M.; Kosmidis, P.; Skarlos, Dimosthenis; Pavlidis, Nicholas

doi:10.1023/a:1008357609434

Cited by 39 publications

(8 citation statements)

References 16 publications

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“…In postoperative trials, only approximately 50 to 80 percent of all patients receive the planned full dose of chemotherapy 12,13 . Therefore, questions arise about whether prognostic factors can be determined from the pathohistologic data after completing neoadjuvant RCT and operation that would allow the patient to forego additional chemotherapy (in the case of a good prognosis) or whether further treatment must be urgently recommended (in the case of an uncertain prognosis).…”

mentioning

confidence: 99%

Postoperative Chemotherapy May Not Be Necessary for Patients With ypN0-Category After Neoadjuvant Chemoradiotherapy of Rectal Cancer

Fietkau

Klautke

et al. 2006

Diseases of the Colon &Amp; Rectum

101

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mentioning

confidence: 99%

Postoperative Chemotherapy May Not Be Necessary for Patients With ypN0-Category After Neoadjuvant Chemoradiotherapy of Rectal Cancer

Fietkau

Klautke

et al. 2006

Diseases of the Colon &Amp; Rectum

101

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“…In the early, chiefl y American trials, both chemotherapy and CRT were predominantly given, and thus it was diffi cult to ascertain which component was responsible for the survival gain [ 8 , 9 ]. In a Hellenic trial [ 79 ], CRT with 4 additional cycles of chemotherapy was not more effective than CRT alone. In a Norwegian trial [ 80 ], CRT alone resulted in a survival gain compared to no postoperative therapy.…”

Section: Postoperative Therapymentioning

confidence: 86%

Radiotherapy and Chemoradiation for Rectal Cancer: State of the Art in Europe, the USA and Asia

Glimelius

2014

Multidisciplinary Treatment of Colorectal Cancer

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In rectal cancer treatment, not only the local primary but also regional and systemic tumour deposits must be taken care of. The three major treatments, surgery, radiotherapy and drugs, each with their own advantages and limitations, must be combined to result in improved outcomes. Several large randomised trials, reviewed here, have proven that combinations of the three modalities have markedly improved the locoregional problem, but not yet had any major infl uence on the systemic problem, and thus overall survival. The best integration of the so far weakest modality, the drugs, is not known. The results of the trials are interpreted differently in the world. A new generation of trials exploring the best sequence of treatments, together with integration of the novel drugs, is required.

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“…In addition two small randomised trials of CRT in the postoperative adjuvant setting also support the view that concurrent chemotherapy is the most effective strategy (Fountzilas et al, 1999;Cafiero et al, 2003). The first paper questions the additional advantage to consolidation chemotherapy following the main strategy of concurrent CRT.…”

Section: Concurrent Chemotherapymentioning

confidence: 99%

Neoadjuvant chemotherapy prior to preoperative chemoradiation or radiation in rectal cancer: should we be more cautious?

et al. 2006

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Neoadjuvant chemotherapy (NACT) is a term originally used to describe the administration of chemotherapy preoperatively before surgery. The original rationale for administering NACT or so-called induction chemotherapy to shrink or downstage a locally advanced tumour, and thereby facilitate more effective local treatment with surgery or radiotherapy, has been extended with the introduction of more effective combinations of chemotherapy to include reducing the risks of metastatic disease. It seems logical that survival could be lengthened, or organ preservation rates increased in resectable tumours by NACT. In rectal cancer NACT is being increasingly used in locally advanced and nonmetastatic unresectable tumours. Randomised studies in advanced colorectal cancer show high response rates to combination cytotoxic therapy. This evidence of efficacy coupled with the introduction of novel molecular targeted therapies (such as Bevacizumab and Cetuximab), and long waiting times for radiotherapy have rekindled an interest in delivering NACT in locally advanced rectal cancer. In contrast, this enthusiasm is currently waning in other sites such as head and neck and nasopharynx cancer where traditionally NACT has been used. So, is NACT in rectal cancer a real advance or just history repeating itself? In this review, we aimed to explore the advantages and disadvantages of the separate approaches of neoadjuvant, concurrent and consolidation chemotherapy in locally advanced rectal cancer, drawing on theoretical principles, preclinical studies and clinical experience both in rectal cancer and other disease sites. Neoadjuvant chemotherapy may improve outcome in terms of disease-free or overall survival in selected groups in some disease sites, but this strategy has not been shown to be associated with better outcomes than postoperative adjuvant chemotherapy. In particular, there is insufficient data in rectal cancer. The evidence for benefit is strongest when NACT is administered before surgical resection. In contrast, the data in favour of NACT before radiation or chemoradiation (CRT) is inconclusive, despite the suggestion that response to induction chemotherapy can predict response to subsequent radiotherapy. The observation that spectacular responses to chemotherapy before radical radiotherapy did not result in improved survival, was noted 25 years ago. However, multiple trials in head and neck cancer, nasopharyngeal cancer, non-small-cell lung cancer, small-cell lung cancer and cervical cancer do not support the routine use of NACT either as an alternative, or as additional benefit to CRT. The addition of NACT does not appear to enhance local control over concurrent CRT or radiotherapy alone. Neoadjuvant chemotherapy before CRT or radiation should be used with caution, and only in the context of clinical trials. The evidence base suggests that concurrent CRT with early positioning of radiotherapy appears the best option for patients with locally advanced rectal cancer and in all disease sites where radiation is the primary l...

show abstract

Postoperative radiation and concomitant bolus fluorouracil with or without additional chemotherapy with fluorouracil and high-dose leucovorin in patients with high-risk rectal cancer: A randomized phase III study conducted by the Hellenic Cooperative Oncology Group

Cited by 39 publications

References 16 publications

Postoperative Chemotherapy May Not Be Necessary for Patients With ypN0-Category After Neoadjuvant Chemoradiotherapy of Rectal Cancer

Postoperative Chemotherapy May Not Be Necessary for Patients With ypN0-Category After Neoadjuvant Chemoradiotherapy of Rectal Cancer

Radiotherapy and Chemoradiation for Rectal Cancer: State of the Art in Europe, the USA and Asia

Neoadjuvant chemotherapy prior to preoperative chemoradiation or radiation in rectal cancer: should we be more cautious?

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