Pre-operative radiotherapy and curative surgery for the management of localized rectal carcinoma

Wong, Rebecca; Tandan, Véd; Silva, Shiroma De; Figueredo, A

doi:10.1002/14651858.cd002102.pub2

Cited by 167 publications

(139 citation statements)

References 147 publications

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“…Contrary to the belief that reduction in local recurrence after radiation increases the likelihood of overall survival, no significant effect in terms of overall survival was found from SRT approach compared with selective postoperative radiation ± chemotherapy [17]. The result was similar with prior meta-analyses [11][12][13][14]. This finding seems to be reasonable, considering the following facts.…”

Section: Discussionsupporting

confidence: 77%

“…By creating the rectum committee and adopting the short-course radiotherapy we have been able to recruit more patients. The Colorectal Cancer Collaborative Group and Wong et al conducted literature-based meta-analyses that focused on preoperative radiation, and they found beneficial effects on local control compared to surgery alone [11,12]. Then, meta-analyses by De Caluwé et al and Ceelen et al demonstrated that preoperative CRT improves local control in resectable stage II and III rectal cancer compared to preoperative RT alone [13,14].…”

Section: Discussionmentioning

confidence: 99%

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Benefits of Neoadjuvant Hypofractionated Radiotherapy in the Treatment of Locally Advanced Adenocarcinomas

Abid¹,

Mansouri²,

Bataiche³

et al. 2017

J Gen Pract

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Background: The current treatment of locally advanced lower and middle rectum's adenocarcinoma is well codified. It is based on neoadjuvant radiotherapy (NRT) followed by surgical excision. However, two broad radiotherapy approaches are being debated: short course of hypo-fractionated radiation therapy "SRT" (5 GY × 5 days) and long course concomitant radio-chemotherapy "CRT" using higher radiation dose (45-50 GY over 5 weeks) combined with chemotherapy. The first approach allows taking care of about 4 times more patients compared to the second in a same period. SRT was introduced at a large scale at the Pierre ET Marie Curie center (Algiers) in May 2010 by a new multidisciplinary board (Rectum board), aiming to reduce long-lasting schedules.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Benefits of Neoadjuvant Hypofractionated Radiotherapy in the Treatment of Locally Advanced Adenocarcinomas

Abid¹,

Mansouri²,

Bataiche³

et al. 2017

J Gen Pract

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“…Two meta-analyses and a systematic review have confirmed this finding [2][3][4]: cancer-specific survival was found to be improved when RT was delivered with biological equivalent doses of .30 Gy pre-operatively. Two further trials have confirmed similar benefit when short-course pre-operative RT was combined with total mesorectal excision (TME) [5,6].…”

mentioning

confidence: 92%

“…The third study demonstrated both reduced local recurrence and reduced acute and late toxicity for pre-operative CRT compared with post-operative CRT [9]. The Cochrane review [4] also examined CRT and concluded that CRT provided incremental benefit in local control, irrespective of the timing of the chemotherapy. These results have led to a significant increase in the use of pre-operative radiation for patients with rectal cancer.…”

mentioning

confidence: 98%

An evaluation of four CT–MRI co-registration techniques for radiotherapy treatment planning of prone rectal cancer patients

Dean

Sykes²,

Cooper³

et al. 2012

BJR

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Objectives: MRI is the preferred staging modality for rectal carcinoma patients. This work assesses the CT-MRI co-registration accuracy of four commercial rigid-body techniques for external beam radiotherapy treatment planning for patients treated in the prone position without fiducial markers. Methods: 17 patients with biopsy-proven rectal carcinoma were scanned with CT and MRI in the prone position without the use of fiducial markers. A reference co-registration was performed by consensus of a radiologist and two physicists. This was compared with two automated and two manual techniques on two separate treatment planning systems. Accuracy and reproducibility were analysed using a measure of target registration error (TRE) that was based on the average distance of the mis-registration between vertices of the clinically relevant gross tumour volume as delineated on the CT image. Results: An automated technique achieved the greatest accuracy, with a TRE of 2.3 mm. Both automated techniques demonstrated perfect reproducibility and were significantly faster than their manual counterparts. There was a significant difference in TRE between registrations performed on the two planning systems, but there were no significant differences between the manual and automated techniques. Conclusion: For patients with rectal cancer, MRI acquired in the prone treatment position without fiducial markers can be accurately registered with planning CT. An automated registration technique offered a fast and accurate solution with associated uncertainties within acceptable treatment planning limits. Randomised trials have demonstrated that adjuvant radiotherapy (RT) in patients with resectable rectal cancer offers a statistically significant reduction in the risk of local recurrence compared with surgery alone [1]. Two meta-analyses and a systematic review have confirmed this finding [2-4]: cancer-specific survival was found to be improved when RT was delivered with biological equivalent doses of .30 Gy pre-operatively. Two further trials have confirmed similar benefit when short-course pre-operative RT was combined with total mesorectal excision (TME) [5,6].Three further randomised trials have evaluated the role of pre-operative adjuvant chemoradiotherapy (CRT) for patients with stage T3-T4 or node-positive disease. Two of these studies demonstrated a reduction in local recurrence when pre-operative adjuvant CRT was used rather than long-course adjuvant RT alone [7,8]. The third study demonstrated both reduced local recurrence and reduced acute and late toxicity for pre-operative CRT compared with post-operative CRT [9]. The Cochrane review [4] also examined CRT and concluded that CRT provided incremental benefit in local control, irrespective of the timing of the chemotherapy. These results have led to a significant increase in the use of pre-operative radiation for patients with rectal cancer.MRI offers increased soft-tissue contrast compared with other radiographic imaging modalities such as CT. This improvement allows the accurate...

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“…Although preoperative radiation clearly decreases local recurrence compared with surgery alone, the magnitude of the benefit was heterogeneous across the trials [5]. Following preoperative chemoradiotherapy, a complete response was defined as having no residual viable tumour cells in the resection specimen.…”

Section: Introductionmentioning

confidence: 99%

Molecular Markers for Recurrence and Sensitivity to Preoperative Chemoradiotherapy in Locally Advanced Rectal Tumours

et al. 2014

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Background: The objective of our study is to provide predictive markers of locally advanced rectal tumour sensitivity to preoperative chemoradiotherapy in order to identify tumours that present a high risk of recurrence after standard total mesorectal excision surgery and preoperative chemoradiotherapy, according to histological response and microsatellite allelic imbalance (AI). Methods: Twenty-nine locally advanced tumours were included in the study and the genomic alterations and the tumour regression grade of paired rectal biopsies (before chemoradiotherapy) and carcinomas (after surgery) were assessed. Clinical and allelotyping data were analysed for local and distant recurrence. Results: The global AI frequency significantly decreased from 47.4 to 20.3% (p < 0.01) after preoperative treatment. Preoperative chemoradiotherapy significantly induced the loss of cells bearing AI at 8 microsatellites: D18S61, D8S264, D1S305, D10S191, D4S394, D14S65, D17S790 and D10S192. Among these, AI at the D8S264 locus was significantly associated with recurrence in our rectal tumour cohort (p = 0.039). Conclusion: Loss of AI at D8S264 is predictive of sensitivity to neoadjuvant treatment; thus, we concluded that the persistence of AI at D8S264 in rectal tumours after preoperative chemoradiotherapy could be considered a molecular marker of recurrence. i 2014 S. Karger AG, Basel

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Pre-operative radiotherapy and curative surgery for the management of localized rectal carcinoma

Cited by 167 publications

References 147 publications

Benefits of Neoadjuvant Hypofractionated Radiotherapy in the Treatment of Locally Advanced Adenocarcinomas

Benefits of Neoadjuvant Hypofractionated Radiotherapy in the Treatment of Locally Advanced Adenocarcinomas

An evaluation of four CT–MRI co-registration techniques for radiotherapy treatment planning of prone rectal cancer patients

Molecular Markers for Recurrence and Sensitivity to Preoperative Chemoradiotherapy in Locally Advanced Rectal Tumours

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