Preoperative Versus Postoperative Chemoradiotherapy for Locally Advanced Rectal Cancer: Results of the German CAO/ARO/AIO-94 Randomized Phase III Trial After a Median Follow-Up of 11 Years

Sauer, Rolf; Liersch, Torsten; Merkel, Susanne; Fietkau, Rainer; Hohenberger, Werner; Hess, Clemens F.; Becker, Heinz; Raab, Hans-Rudolf; Villanueva, M. Teresa; Witzigmann, Helmut; Wittekind, Christian; Beißbarth, Tim; Rödel, Claus

doi:10.1200/jco.2011.40.1836

Cited by 1,764 publications

(1,237 citation statements)

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“…For these patients, neoadjuvant chemoradiotherapy followed by total mesorectal excision (TME) is the standard regimen [2] [3]. It has been reported that preoperative neoadjuvant chemoradiotherapy not only decreases the local recurrent probability, but also increases the anus preservation rate when compared to postoperative chemoradiotherapy [4].…”

Section: Introductionmentioning

confidence: 99%

Dosimetric Comparison of Volumetric Modulated Arc Therapy (VMAT), 5F Intensity Modulated Radiotherapy (IMRT) and 3D Conformal Radiotherapy (3DCRT) in Rectal Carcinoma Receiving Neoadjuvant Chemoradiotherapy

Wen¹,

Zhang²,

Chi³

et al. 2015

IJMPCERO

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Objective: To investigate better dosimetric distribution of volumetric modulated arc therapy (VMAT) vs. 5F intensity modulated radiotherapy (IMRT) and 3D conformal radiotherapy (3DCRT) in patients with locally advanced rectal cancer (LARC) when treated with neoadjuvant chemoradiotherapy. Methods: 3D-CRT, 5F-IMRT and VMAT plans for preoperative radiotherapy were designed in 12 patients with locally advanced rectal cancer. The conformity index (CI) and homogeneity index (HI) in target volume, and the dose and volume of the organs at risk (OAR) irradiated including small bowel, bladder and bilatera1 femoral heads were compared among the three plans. Results: The CI for planning target volume (PTV) 2 and HI for PTV1 of VMRT and 5F-IMRT were superior to 3D-CRT. The CI of VMAT, 5F-IMRT and 3D-CRT plans were 0.71, 0.69 and 0.62 (p = 0.011 and p = 0.019, respectively). The HI of the VMAT and 5F-IMRT plans were both 1.04 and 3D-CRT planning was 1.06 (p = 0.022 and p = 0.006, respectively). The V35 -V45 of small bowel * Corresponding authors. G. Wen et al. 55in VMAT were significantly less than in 5F-IMRT and 3D-CRT. V35 was 47.0, 56.4, and 72.8 cm 3 for VMAT, 5F-IMRT, and 3D-CRT (p = 0.021 and p = 0.034, respectively), while V40 was 30.5, 35.5, 45.1 cm 3 (p = 0.024 and p = 0.032, respectively) and V45 was 15.1, 18.1, 30.0 cm 3 (p = 0.033 and p = 0.032, respectively). The D5, V30 and V50 of bladder in 3D-CRT were less than in VMAT and 5F-IMRT planning (p = 0.034, 0.004, 0.002 and p = 0.027, 0.003, 0.002, respectively). The Dmean of left femoral head in VMAT and 5F-IMRT were less than in 3D-CRT planning (p = 0.028 and p = 0.022, respectively) and the Dmean, V30 of right femoral head in VMAT and 5F-IMRT were better than in 3D-CRT planning (p = 0.044, 0.036 and p = 0.023, 0.028, respectively). Conclusions: Dosimetric analyses demonstrated that IMRT is superior to 3D-CRT in the conformity and homogeneity of dose distribution to the target volume, and provide a better protection to OARs sparing in patients with locally advanced rectal cancer for preoperative radiotherapy. With similar target coverage, VMRT is superior to 5F-IMRT in normal tissue sparing.

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Section: Introductionmentioning

confidence: 99%

Dosimetric Comparison of Volumetric Modulated Arc Therapy (VMAT), 5F Intensity Modulated Radiotherapy (IMRT) and 3D Conformal Radiotherapy (3DCRT) in Rectal Carcinoma Receiving Neoadjuvant Chemoradiotherapy

Wen¹,

Zhang²,

Chi³

et al. 2015

IJMPCERO

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“…Perez et al 133 have reported a 15% LR rate after LE at 15 months in 27 patients with clinical stage II or III disease who experienced a partial clinical response after CRT. Because the median time to LR in patients with LARC treated by TME after CRT is 3 years, and because almost one third of recurrences are diagnosed after 5 years, 134 it can be expected that the recurrence rate will continue to increase as follow-up matures. In addition, recent work by Park et al 48 noted that patients with an intermediate (ypT1-2N0) or poor (ypT3-4 or Nϩ) response experienced significantly worse 5-year PFS, LR, and distant recurrence compared with patients with a pCR, suggesting more aggressive biologic behavior.…”

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confidence: 99%

Advances and Challenges in Treatment of Locally Advanced Rectal Cancer

Smith

Garcia‐Aguilar

2015

JCO

175

114

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Dramatic improvements in the outcomes of patients with rectal cancer have occurred over the past 30 years. Advances in surgical pathology, refinements in surgical techniques and instrumentation, new imaging modalities, and the widespread use of neoadjuvant therapy have all contributed to these improvements. Several questions emerge as we learn of the benefits or lack thereof for components of the current multimodality treatment in subgroups of patients with nonmetastatic locally advanced rectal cancer (LARC). What is the optimal surgical technique for distal rectal cancers? Do all patients need postoperative chemotherapy? Do all patients need radiation? Do all patients need surgery, or is a nonoperative, organ-preserving approach warranted in selected patients? Answering these questions will lead to more precise treatment regimens, based on patient and tumor characteristics, that will improve outcomes while preserving quality of life. However, the idea of shifting the treatment paradigm (chemoradiotherapy, total mesorectal excision, and adjuvant therapy) currently applied to all patients with LARC to a more individually tailored approach is controversial. The paradigm shift toward organ preservation in highly selected patients whose tumors demonstrate clinical complete response to neoadjuvant treatment is also controversial. Herein, we highlight many of the advances and resultant controversies that are likely to dominate the research agenda for LARC in the modern era.

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“…The benefit of radiotherapy is not limited in long-term local control of the disease, as was shown in an update of the German Trial after 11 years of follow-up [20]. One of the main consequences is its capability to lead to tumor regression on different levels: the size of primary tumor (downsizing) and the depth of wall and nodes infiltration (downstaging).…”

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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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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Preoperative Versus Postoperative Chemoradiotherapy for Locally Advanced Rectal Cancer: Results of the German CAO/ARO/AIO-94 Randomized Phase III Trial After a Median Follow-Up of 11 Years

Cited by 1,764 publications

References 14 publications

Dosimetric Comparison of Volumetric Modulated Arc Therapy (VMAT), 5F Intensity Modulated Radiotherapy (IMRT) and 3D Conformal Radiotherapy (3DCRT) in Rectal Carcinoma Receiving Neoadjuvant Chemoradiotherapy

Dosimetric Comparison of Volumetric Modulated Arc Therapy (VMAT), 5F Intensity Modulated Radiotherapy (IMRT) and 3D Conformal Radiotherapy (3DCRT) in Rectal Carcinoma Receiving Neoadjuvant Chemoradiotherapy

Advances and Challenges in Treatment of Locally Advanced Rectal Cancer

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

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