Short course continuous, hyperfractionated, accelerated radiation therapy (CHART) as preoperative treatment for rectal cancer

Brooks, Susan A.; Glynne‐Jones, Robert; Novell, Richard; Harrison, Mark; Brown, Katherine Kay; Makris, Andreas

doi:10.1080/02841860600897900

Cited by 21 publications

(20 citation statements)

References 30 publications

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“…In an experimental study, the tumour cell kill was similar using 5 )/5 Gy and 10 )/3 Gy (2 daily fractions 6 hours apart) in 5 days, and superior to 10 )/3 Gy in 10 days [23]. Two of the clinical trials are published in this issue of Acta Oncologica [24,25]. These studies build upon the limited knowledge of the relations between fraction size, total dose and treatment time on the one hand and acute (tumour and normal tissue) and late toxicity on the other, as expressed in the so called 'biological models'.…”

mentioning

confidence: 99%

“…The CHART study [24] is too small to evaluate antitumour activity, although 3 year locoregional control was good (95%). Acute toxicity was, as expected low, but one patient had to stop therapy due to nausea and vomiting (virtually never seen after 5 )/5 Gy [29,30], and two (10%) died postoperatively.…”

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confidence: 99%

“…Brooks et al [24] from Mount Vernon Cancer Centre, UK treated 20 patients with clinical stage T3 rectal cancer with a continuous hyperfractionated, accelerated radiation therapy (CHART). The patients received 25 Gy in 15 fractions of 1.67 Gy in 5 days, i.e.…”

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confidence: 99%

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Rectal cancer irradiation. Long course, short course or something else?

Glimelius

2006

Acta Oncologica

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Rectal cancer irradiation. Long course, short course or something else?

Glimelius

2006

Acta Oncologica

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“…Biologically equivalent doses (in 2 Gy/fr) to 5 5 Gy I very much thank Dr Courdi for detecting the mistakes and uncertainties in the table in my editorial [1] and in the article by Brooks et al [2]. It is our responsibility to detect mistakes in submitted and accepted papers and definitely not to in an inattentive way replicate them.…”

Section: In Reply To Dr Courdimentioning

confidence: 99%

In reply to Dr Courdi

Glimelius¹,

Isacsson²

2007

Acta Oncologica

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“…To our knowledge, only one study has been reported attempting to integrate chemotherapy into SCPRT (5 x 5 Gy). 23 Hence, some investigators have modified SCPRT (5 x 5 Gy) to a hyperfractionated RT regimen with a view to reducing late effects, [39][40][41] and potentially integrating chemotherapy. A further study also modified SCPRT in rectal cancer to deliver twice-daily Extending the Interval to Surgery SCPRT followed by local excision of small, radioresponsive tumours in elderly patients achieves an acceptable LR rate.…”

Section: Developments In Short-course Preoperative Radiotherapy Integmentioning

confidence: 99%

How to Select for Preoperative Short-course Radiotherapy, While Considering Long-course Chemoradiotherapy or Immediate Surgery, and Who Benefits?

Glynne-Jones¹,

Dt²,

Moran³

et al. 2014

European Oncology &Amp; Haematology

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The management of patients with locally advanced rectal cancer (LARC) has evolved with the aim of reducing local recurrence and improving survival. Current practice has developed from refinements in surgical technique, the availability of different types of preoperative imaging, the selective or blanket use of neoadjuvant treatment (usually radiation) and sophisticated efforts exploring multimodality treatments to achieve organ preservation. Both short-course preoperative radiotherapy (SCPRT) and long-course chemoradiation (CRT) are considered standard neoadjuvant strategies, which are advocated in different parts of the world. New techniques in the delivery of radiotherapy, such as intensity-modulated radiotherapy (IMRT), may allow more precise dosing to the target volume (tumour and/or locoregional lymph nodes) and limit radiation doses to critical normal structures; however, current schedules of SCPRT and CRT impact on late function, and if they do not improve survival in resectable cancers, can they be omitted in selected cases? KeywordsRectal adenocarcinoma, neoadjuvant radiation, chemoradiation, chemotherapy, short-course preoperative radiation, long-course chemoradiation Disclosure: Rob Glynne-Jones has received honoraria for lectures and advisory boards and has been supported in attending international meetings in the last five years by Eli Lilly, Merck, Pfizer, Sanofi-Aventis and Roche. He has received unrestricted grants for research from Merck-Serono, Sanofi-Aventis and Roche. He is principal investigator of a randomised phase II neoadjuvant chemotherapy study in the UK called BACCHUS. David Tan In patients with locally advanced rectal cancer (LARC), not involving the mesorectal fascia (MRF), surgery with total mesorectal excision (TME) is the standard of care. Prior to the TME era, high rates of local recurrence (LR) were observed after radical surgery, and 10-40 % of patients required a permanent stoma, even for tumours arising in the mid/upper rectum. In the 1990s, randomised trials 1-3 established shortcourse preoperative pelvic radiotherapy (SCPRT) using 5 x 5 Gy as a component of the curative treatment of resectable and early rectal cancers. These historical trials reported LR rates of 20-30 % after surgery alone, reflecting the suboptimal surgical practice at the time.Two subsequent trials examined whether SCPRT simply compensated for poor surgical technique, i.e. whether SCPRT still reduced LR if TME was performed. By then, it was recognised that the risk of LR, after a potentially curative resection, is mainly explained by microscopic tumour cells within 1 mm of the circumferential resection margin (CRM). 4 Hence, in the control group in the event of a histopathological involved CRM, postoperative RT or chemoradiotherapy was intended in the Dutch TME study 5 and CR07 trial,6 respectively. Both trials confirmed a reduction in LR, but overall survival (OS) was not improved, and the risk of metastases predominated over LR. [5][6][7][8] During the same period, the strategy of postoperativ...

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Short course continuous, hyperfractionated, accelerated radiation therapy (CHART) as preoperative treatment for rectal cancer

Cited by 21 publications

References 30 publications

Rectal cancer irradiation. Long course, short course or something else?

Rectal cancer irradiation. Long course, short course or something else?

In reply to Dr Courdi

How to Select for Preoperative Short-course Radiotherapy, While Considering Long-course Chemoradiotherapy or Immediate Surgery, and Who Benefits?

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