Survival after Postoperative Combination Treatment of Rectal Cancer

Ho, Douglass; Cg, Moertel; Mayer, Roland; Pr, Thomas; As, Lindblad; Mittleman, Arnold; Dm, Stablein; Bruckner, Howard W.

doi:10.1056/nejm198611133152014

Cited by 463 publications

(26 citation statements)

References 2 publications

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“…Postoperatively, radiochemotherapy, rather than radiotherapy alone, has been used in several of the trials and has tended to decrease local failure rates and significantly improve survival compared with surgery alone or surgery and postoperative radiotherapy (table 1) [38, 39, 40, 41, 42]. A survival benefit was, however, seen with postoperative chemotherapy alone without any radiotherapy in the trial (Protocol R-01) conducted by the National Surgical Adjuvant Breast and Bowel Project (NSABP) [41].…”

Section: Clinical Effects In Abdominal Malignanciesmentioning

confidence: 99%

“…The consensus statement was based upon the results of three of the randomised trials mentioned above [38, 39, 40, 41]. The results of the studies can, however, be interpreted differently; it is actually possible that the survival benefit may be ascribed to the systemic effects of the chemotherapy component and not to improved local control offered by, for example, radiosensitization.…”

Section: Clinical Effects In Abdominal Malignanciesmentioning

confidence: 99%

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Role of Adjuvant Chemoradiotherapy for Abdominal Malignancies

Glimelius¹

2003

Dig Surg

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The rationale for combining surgery, radiotherapy and chemotherapy is discussed and the clinical results seen with surgery and adjuvant radiochemotherapy in three major abdominal malignancies are reviewed. A systematic approach to the literature was used. In rectal cancer, postoperative radiochemotherapy is an established treatment, although there is weak scientific support for the combined approach. The same clinical gains can also be reached much more easily with preoperative radiotherapy. In gastric cancer, a recent large randomised trial showed improved survival from postoperative radiotherapy. This was not seen in a comparably large trial in pancreatic cancer. The reasons for the different results according to primary tumour site are discussed. It is argued that adequate coverage of all adjacent regional lymph node stations is necessary for an effect on survival.

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Section: Clinical Effects In Abdominal Malignanciesmentioning

confidence: 99%

Section: Clinical Effects In Abdominal Malignanciesmentioning

confidence: 99%

Role of Adjuvant Chemoradiotherapy for Abdominal Malignancies

Glimelius¹

2003

Dig Surg

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“…This guideline was based on the results of several large randomized controlled trials [2][3][4] and became the standard of care for patients with stage II/III rectal cancer in the United States. More recent studies have shown that pre-operative (neoadjuvant) chemoradiotherapy significantly reduces local recurrence rates [5][6][7][8][9] and improves disease-free survival among stage II/III rectal cancer patients [9,10].…”

Section: Introductionmentioning

confidence: 99%

Timing of Adjuvant Chemotherapy and Survival in Patients with Stage II/III Rectal Cancer

Lima¹,

Yasui²,

Scarfe³

et al. 2012

JCT

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Background: Treatment guidelines in the 1990s established surgery followed by chemoradiotherapy as the standard treatment for stage II/III rectal cancer. Our aim was to investigate the association between the timing of adjuvant treatment and patient survival in practice and identify demographic/clinical factors associated with treatment patterns. Methods: All residents of Alberta diagnosed with stage II/III rectal adenocarcinoma in 2000-2005 who had surgery were included in the study. Demographic and clinical data were obtained from the Alberta Cancer Registry and linked to hospital data and socioeconomic data from the 2001 Canadian Census. Overall and cancer-specific hazard ratios of death were estimated using Cox proportional hazards models. Results: 1243 patients were included in the study; 636 (51%) patients received treatment consistent with guidelines. Patients who received adjuvant chemotherapy 12 -16 weeks after surgery or more than 16 weeks/ did not receive it had a 43% and 58% higher risk of rectal cancer death, respectively, compared to those who received it within 8 weeks of surgery. Conclusion: Adjuvant chemotherapy for stage II/III rectal cancer should be initiated within 12 weeks after surgery to maximize treatment benefits. Efforts to increase the proportion of patients treated within 12 weeks after surgery are needed.

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“…Adjuvant chemoradiotherapy (CRT) has been validated to improve both local control and survival in patients with advanced (≥T 3–4 N 0–2 M₀) rectal carcinoma [1, 2]. However, postoperative pelvic radiation therapy (RT) may be associated with significant dose-limiting bowel toxicity [3, 4].…”

Section: Introductionmentioning

confidence: 99%

Octreotide in the Management of Chemoradiotherapy-Induced Diarrhea Refractory to Loperamide in Patients with Rectal Carcinoma

Topkan

Karaoğlu

2006

Oncology

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Objective: To evaluate the efficacy of octreotide in the treatment of chemoradiotherapy (CRT)-induced diarrhea (CRTID) refractory to conventional loperamide treatment in this pilot study. Methods: Forty-two rectal carcinoma (T_3–4N_0–2M₀) patients with grade 2 or 3 diarrhea refractory to loperamide were enrolled to receive octreotide. Eligible patients were treated with pelvic radiotherapy combined with bolus 5- fluorouracil CRT. Octreotide was administered subcutaneously, 150 µg three times daily, for 5 consecutive days. Only complete resolution of diarrhea was considered as therapeutic success. Results: Diarrhea mainly occurred in the first 4 weeks of CRT (83.3%) and completely resolved in 34 patients (80.9%) following octreotide administration. Mean time to response was 2.7 days: 27 patients (64%) responded during the first 3 days, and the remaining 7 (17%) on days 4 and 5. No significant side effect was reported. Eight patients (19.1%) with refractory diarrhea were hospitalized for additional treatment. No treatment delay was reported in complete responders, whereas an average 7.7-day delay was observed in refractory patients. Antidiarrheal treatment was administered on an outpatient basis in the response group, whereas refractory patients were hospitalized for an average of 8.8 days. Conclusion: Daily subcutaneous octreotide administration (150 µg t.i.d.) for 5 days is apparently an effective, tolerable treatment modality for concurrent CRTID refractory to loperamide.

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Survival after Postoperative Combination Treatment of Rectal Cancer

Cited by 463 publications

References 2 publications

Role of Adjuvant Chemoradiotherapy for Abdominal Malignancies

Role of Adjuvant Chemoradiotherapy for Abdominal Malignancies

Timing of Adjuvant Chemotherapy and Survival in Patients with Stage II/III Rectal Cancer

Octreotide in the Management of Chemoradiotherapy-Induced Diarrhea Refractory to Loperamide in Patients with Rectal Carcinoma

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