“Sandwich” preoperative and postoperative combined chemotherapy and radiation in tethered and fixed rectal cancer: Impact of treatment intensity on local control and survival

Complete Pathologic Response Following Preoperative Chemoradiation Therapy for Middle to Lower Rectal Cancer Is Not a Prognostic Factor for a Better Outcome

“…The absence of viable cancer cells (pCR) on the resected specimen following this treatment ranges from 4 percent to 44 percent of cases. 2,8,[10][11][12] The reasons for this wide variability in response are unclear, and the results of studies reporting on clinicopathologic factors predictive of tumor response are controversial. Discrepancies between studies are mainly related to differences in patient selection, accuracy of preoperative staging and pathologic reports, and differences in treatments and definitions used for tumor response.…”

T-Level Downstaging and Complete Pathologic Response After Preoperative Chemoradiation for Advanced Rectal Cancer Result in Decreased Recurrence and Improved Disease-Free Survival

“…10,15,16,[35][36][37][38] On the other hand, despite the potential for underestimating the response to CRT, the reduction of T or N stage to define downstaging is commonly used. 18,21,39 Simple palpation of the cancer to determine the depth and degree of margins is inaccurate. 40 CT scans are rated poor in determining T-level and N-staging, with accuracy rates ranging from 61 to 70 percent and from 26 to 35 percent, respectively.…”

“…21 Despite the fact that increased toxicity during the neoadjuvant period has been attributed to CRT, most of the complications are not severe and can be managed easily. 15,18,[35][36][37] Although evaluation of the toxicity of preoperative CRT was not an objective of this study, we have encountered 25 percent Grade 3 toxicity (10 percent severe diarrhea, 2 percent skin desquamation, 4 percent oral ulcerations, 7 percent neutropenia, and 2 percent infections) and 12 percent hospitalization rate (our unpublished data). Postoperative morbidity remains another important issue.…”

“…7 tive combined modality treatment in the management of rectal cancer (Table 1). [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] Preoperative CRT offers several potential advantages. It reduces acute toxicity by avoiding radiation to the neorectum and increases efficacy by irradiating well-oxygenated tissues.…”

Neoadjuvant treatment for locally advanced rectal carcinoma

“…Only three [35][36][37] (two of which prematurely closed because of poor accrual and the third one still ongoing) of multiple randomised trials [22][23][24][25][26][38][39][40][41][42] supported its superiority over postoperatory radiochemotherapy. In the German study [37], 805 patients with locally advanced operable rectal cancer were randomly assigned to pre or postoperative radiochemotherapy, a total dose of 50.4 Gy (single dose 1.8 Gy) was applied to the tumor and the pelvic lymph nodes.…”