Preoperative neo‐adjuvant therapy for curable rectal cancer – reaching a consensus 2008

Abstract

Objective Our aim was to determine the range of neo-adjuvant therapy the multidisciplinary team (MDT) currently offers patients with curable (M 0 ) rectal cancer.Method A senior oncologist from each of the four oncology centres in north Wales and the north-west of England (approximate target population 8 million -Glan Clwyd, Clatterbridge, Christie and Preston) reviewed his ⁄ her understanding of the current evidence of neoadjuvant therapy in rectal cancer. Then a representative from each centre was asked to identify which of three neo-adjuvant options (no neo-adjuvant therapy, shortcourse radiotherapy 25 Gy over five fractions and longcourse chemoradiotherapy) he ⁄ she would use for a rectal cancer in the upper, middle or lower third of the rectum staged by magnetic resonance imaging as being T 2 -T 4 and ⁄ or N 0 -N 2 .Results In all cases of locally advanced rectal cancer (T 3a N 1 -T 4 ), oncologists from the four oncology centres recommended long-course chemoradiotherapy before rectal resection. This consensus was maintained for cases of lower third T 3a N 0 cancers. Thereafter, the majority of patients with rectal cancer are offered adjuvant shortcourse radiotherapy.Conclusion Neo-adjuvant therapy is less likely to be offered if the tumour is early (T 2 , N 0 ) and ⁄ or situated in the upper third of the rectum.

Outcomes in locally advanced rectal cancer with highly selective preoperative chemoradiotherapy

“…Although surgery remains the primary treatment for rectal cancer, there is current consensus that preoperative RT helps to achieve optimal outcomes. Reported advantages of neoadjuvant treatment are reduction in local recurrence rates , to enable surgery in otherwise unresectable rectal cancer and to allow non‐operative treatment in complete responders, although some of these benefits remain controversial.…”

Prognosis Factors for Recurrence in Patients With Locally Advanced Rectal Cancer Preoperatively Treated With Chemoradiotherapy and Adjuvant Chemotherapy

“…[5][6][7][8][9][10][11][12] on this basis, for locally advanced rectal cancer (laRC), neoadjuvant CRt followed by surgery is currently the preferred treatment option. 5,[13][14][15] adjuvant chemotherapy (Cht) is usually recommended, although controversy exists in patients who have been rendered node negative by preoperative treatment. 15,16 the multidisciplinary management of laRC has translated into a decrease in the rate of local failure.…”

A Retrospective Analysis on Two-week Short-course Pre-operative Radiotherapy in Elderly Patients with Resectable Locally Advanced Rectal Cancer

“…Although surgery remains the primary treatment for rectal cancer, the current consensus dictates that pre-operative treatments help to achieve optimal outcomes14. The reported advantages of neo-adjuvant treatment are the reduction in local recurrence rates15, the ability to perform surgery in patients with stage II or III rectal cancer and an increase in OS and DFS.…”