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Randomized trials of adjuvant radiation therapy for rectal carcinoma: A review

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Diseases of the Colon & Rectum

Abstract

An estimated 44,000 cases of rectal carcinoma arise annually in the United States. The traditional management of this disease has been surgery alone, but advances in adjuvant therapy offer potential for improvement of local control, disease-free survival, and survival. In the last two decades, many multicenter randomized trials of adjuvant preoperative and postoperative radiation therapy for rectal carcinoma have been reported. The design and results of these trials are critically reviewed. Results from preoperative trials have been conflicting, reflecting the heterogeneity of the trial designs. Large postoperative adjuvant trials have been reported recently. The combined analysis of local recurrence data from the mature, published trials indicates that radiation therapy results in improved local control (P=0.02), an important concern in rectal carcinoma as local recurrences present vexing and painful clinical problems often refractory to conventional management. These trials also have shown that radiation therapy can contribute to improved survival in the combined modality setting. Improvements in the clinical outcome of rectal cancer should be possible with appropriate adjuvant therapy. The success of combined modality adjuvant therapy for rectal carcinoma may serve as a model to aid in the design of therapeutic regimens for other solid tumors.

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References

  1. American Cancer Society: Cancer statistics, 1989. CA 1989;39:1–32.

    Article  Google Scholar 

  2. Higgins GA. Adjuvant therapy for carcinoma of the colon and rectum. Int Adv Surg Oncol 1984;7:77–111.

    PubMed  CAS  Google Scholar 

  3. Williams NS. Changing patterns in the treatment of rectal cancer. Br J Surg 1989;76:5–6.

    PubMed  CAS  Google Scholar 

  4. Rosen L, Veidenheimer MC, Coller JA, Corman ML. Mortality, morbidity, and patterns of recurrence after abdominoperineal resection for cancer of the rectum. Dis Colon Rectum 1982;25:202–8.

    PubMed  CAS  Google Scholar 

  5. Gunderson LL, Sosin H. Areas of failure found at reoperation (second or symptomatic look) following “curative surgery” for adenocarcinoma of the rectum: clinicopathologic correlation and implications for adjuvant therapy. Cancer 1974;34:1278–92.

    PubMed  CAS  Google Scholar 

  6. Cass AW, Million RR, Pfaff WW. Patterns of recurrence following surgery alone for adenocarcinoma of the colon and rectum. Cancer 1976;37:2861–5.

    PubMed  CAS  Google Scholar 

  7. Rich T, Gunderson LL, Lew R, Galdibini JJ, Cohen AM, Donaldson G. Patterns of recurrence of rectal cancer after potentially curative surgery. Cancer 1983;52:1317–29.

    PubMed  CAS  Google Scholar 

  8. Cummings BJ. Adjuvant radiation therapy for rectal adenocarcinoma. Dis Colon Rectum 1984;27:826–36.

    PubMed  CAS  Google Scholar 

  9. Beart RW, Martin JK, Gunderson LL. Management of recurrent rectal cancer. Mayo Clin Proc 1986;61:448–50.

    PubMed  Google Scholar 

  10. Gilbert SG. Symptomatic local tumor failure following abdominoperineal resection. Int J Radiol Oncol Biol Phys 1978;4:801–7.

    CAS  Google Scholar 

  11. Mohiuddin M, Derdel J, Marks G, Kramer S. Results of adjuvant radiation therapy in cancer of the rectum: Thomas Jefferson University Hospital experience. Cancer 1985;55:350–3.

    PubMed  CAS  Google Scholar 

  12. Marks G, Mohiuddin M, Goldstein SD. Sphincter preservation for cancer of the distal rectum using high dose preoperative radiation. Int J Radiat Oncol Biol Phys 1988;15:1065–8.

    PubMed  CAS  Google Scholar 

  13. Stearns MW, Deddish MR, Quan SH. Preoperative radiation therapy for cancer of the rectum. Surg Gynecol Obstet 1959;109:225–9.

    PubMed  Google Scholar 

  14. Kligerman MM. Preoperative radiation therapy in rectal cancer. Cancer 1975;36:691–5.

    PubMed  CAS  Google Scholar 

  15. Rider WD. Is the Miles operation really necessary for the treatment of rectal cancer. Can Assoc Radiol J 1975;26:167–75.

    CAS  Google Scholar 

  16. Rider WD, Palmer JA, Mahoney LJ, Robertson CT. Preoperative irradiation in operable cancer of the rectum: report of the Toronto trial. Can J Surg 1977;20:335–8.

    PubMed  CAS  Google Scholar 

  17. Higgins GA, Conn JH, Jordan PH, Humphrey EW, Roswit B, Keehn RJ. Preoperative radiotherapy for colorectal cancer. Ann Surg 1975;181:624–30.

    PubMed  Google Scholar 

  18. Roswit B, Higgins GA, Keehn RJ. Preoperative irradiation for carcinoma of the rectum and rectosigmoid colon: report of a national Veterans Administration randomized study. Cancer 1975;35:1597–1602.

    PubMed  CAS  Google Scholar 

  19. Medical Research Council Working Party. A trial of preoperative radiotherapy in the management of operable rectal cancer: first report of an MRC Working Party. Br J Surg 1982;69:513–9.

    Google Scholar 

  20. Medical Research Council Working Party. The evaluation of low dose pre-operative x-ray therapy in the management of operable rectal cancer-results of a randomly controlled trial: Second report of an MRC Working Party. Br J Surg 1984;71:21–6.

    Google Scholar 

  21. Higgins GA, Humphrey EW, Dwight RW, Roswit B, Lee LE, Keehn RJ. Preoperative radiation and surgery for cancer of the rectum: Veterans Administration Surgical Oncology Group Trial II. Cancer 1986;58:352–9.

    PubMed  CAS  Google Scholar 

  22. Stockholm Rectal Cancer Study Group. Short-term preoperative radiotherapy for adenocarcinoma of the rectum. Am J Clin Oncol 1987;10:369–75.

    Article  Google Scholar 

  23. Gerard A, Berrod J-L, Pene F, et al. Interim analysis of a phase III study on preoperative radiation therapy in resectable rectal carcinoma. Cancer 1985;55:2373–9.

    PubMed  CAS  Google Scholar 

  24. Gerard A, Buyse M, Nordlinger B, et al. Preoperative radiotherapy as adjuvant treatment in rectal cancer. Ann Surg 1988;208:606–14.

    PubMed  CAS  Google Scholar 

  25. Fowler JF. The linear quadratic formula and progress in fractionated radiotherapy-a review. Br J Radiol 1989;62:679–94.

    Article  PubMed  CAS  Google Scholar 

  26. Haghbin M, Sischy B, Hinson J. Combined modality preoperative therapy in poor prognosis rectal adenocarcinoma. Radiother Oncol 1988;13:75–81.

    PubMed  CAS  Google Scholar 

  27. Gastrointestinal Tumor Study Group. Prolongation of the diseasefree interval in surgically treated rectal carcinoma. N Engl J Med 1985;312:1465–72.

    Article  Google Scholar 

  28. Gastrointestinal Tumor Study Group. Survival after postoperative combination treatment of rectal cancer. N Engl J Med 1986;315:1294–5.

    Article  Google Scholar 

  29. Thomas PR, Linblad AS. Adjuvant postoperative radiotherapy and chemotherapy in rectal carcinoma: a review of the Gastrointestinal Tumor Study Group experience. Radiother Oncol 1988;13:245–52.

    PubMed  CAS  Google Scholar 

  30. Fisher B, Wolmark N, Rockette H, et al. Postoperative adjuvant chemotherapy or radiation therapy for rectal cancer: results from NSABP protocol R-01. J Nat Cancer Inst 1988;80:21–9.

    PubMed  CAS  Google Scholar 

  31. Wolmark N, Haller D, Allegra J. Chemotherapy of colorectal cancer. In: Spratt JS. Neoplasms of the colon, rectum, and anus; mucosal and epithelial. Philadelphia: WB Saunders, 1984:347–62.

    Google Scholar 

  32. O'Connell MJ, Gunderson LL, Fleming TR. Surgical adjuvant therapy of rectal cancer. Semin Oncol 1988;15:138–45.

    PubMed  Google Scholar 

  33. Krook J, Moertel C, Wieand H, et al. Radiation vs. sequential chemotherapy-radiation-chemotherapy: a study of the North Central Cancer Treatment Group, Duke University, and the Mayo Clinic (abstr). Proc Am Soc Clin Oncol 1986;5:82.

    Google Scholar 

  34. Gunderson LL, Martenson JA. Radiation therapy in colorectal cancer. In: Brain MC, Carbone PP. Current therapy in hematology-oncology-3. Philadelphia: BC Decker, 1988:194–200.

    Google Scholar 

  35. Cohen AM, Shank B, Friedman MA. Colorectal cancer. In: De Vita VT, Hellman S, Rosenberg SA. Cancer: principles and practice of oncology. 3rd ed. Philadelphia: JB Lippincott, 1989:940.

    Google Scholar 

  36. Fleiss JL. Statistical methods for rates and proportions. New York: John Wiley & Sons, 1981:160–8.

    Google Scholar 

  37. Carlsson U, Lasson, Ekelund G. Recurrence rates after curative surgery for rectal carcinoma, with special reference to their accuracy. Dis Colon Rectum 1987;30:431–4.

    PubMed  CAS  Google Scholar 

  38. Devereux DF, Chandler JJ, Eisenstat T, Zinkin L. Efficacy an absorbable mesh in keeping the small bowel out of the human pelvis following surgery. Dis Colon Rectum 1988;31:17–21.

    PubMed  CAS  Google Scholar 

  39. Devereux DF, Eisenstat T, Zinkin L. The safe and effective use of postoperative radiation therapy in modified Astler Coller stage C3 rectal cancer. Cancer 1989;63:2393–6.

    PubMed  CAS  Google Scholar 

  40. Gunderson LL, Russell AH, Llewellyn HD, Doppke KP, Tepper JE. Treatment planning for colorectal cancer: radiation and surgical techniques and value of small bowel films. Int J Radiat Oncol Biol Phys 1985;11:1379–93.

    PubMed  CAS  Google Scholar 

  41. Boice JD, Greene MH, Killen JY, et al. Leukemia and preleukemia after adjuvant treatment of gastrointestinal cancer with semustine (methyl-CCNU). N Engl J Med 1983;309:1079–84.

    Article  PubMed  Google Scholar 

  42. Fisher B, Wolmark N, Rockette H, et al. Postoperative adjuvant chemotherapy or BCG for colon cancer: results from NSABP protocol C-01. J Nat Cancer Inst 1988;80:30–6.

    PubMed  Google Scholar 

  43. Intergroup -86-47-51 (NCCTG 86-47-51, RTOG 88-11, ECOG EST-1288) Phase III Protocol for Surgical Adjuvant Therapy of Rectal Carcinoma. A controlled evaluation of protractedinfusion 5-fluorouracil as a radiation enhancer and 5-FU plus methyl-CCNU chemotherapy.

  44. NSABP Protocol R-02. A clinical trial to compare adjuvant methylCCNU, vincristine, 5-fluorouracil (MOF) with and without radiation to adjuvant leucovorin and 5-fluorouracil (LV-5-FU) with and without radiation in patients with Dukes' B and C carcinoma of the rectum.

  45. Fleming TR, Watelet LF. Approaches to monitoring clinical trials. J Nat Cancer Inst 1989;81:188–93.

    PubMed  CAS  Google Scholar 

  46. Buyse M, Zeleniuch-Jacquotte A, Chalmers TC. Adjuvant therapy of colorectal cancer: why we still don't know. JAMA 1988;259:3571–8.

    PubMed  CAS  Google Scholar 

  47. Duncan W. Adjuvant radiotherapy in rectal cancer: the MRC trials. Br J Surg 1985;72:S59–62.

    PubMed  Google Scholar 

  48. Perez CA, Brady LW. Principles and practice of radiation oncology. Philadelphia: JB Lippincott, 1987:52.

    Google Scholar 

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Authors and Affiliations

  1. Department of Radiation Oncology, University of Pennsylvania/Fox Chase Cancer Center, Central and Shelmire Avenues, 19111, Philadelphia, Pennsylvania

    Seth A. Rosenthal M.D. &  Lawrence R. Coia M.D.

  2. Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, Pennsylvania

    Bruce J. Trock Ph.D.

Authors
  1. Seth A. Rosenthal M.D.
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  2. Bruce J. Trock Ph.D.
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  3. Lawrence R. Coia M.D.
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Rosenthal, S.A., Trock, B.J. & Coia, L.R. Randomized trials of adjuvant radiation therapy for rectal carcinoma: A review. Dis Colon Rectum 33, 335–343 (1990). https://doi.org/10.1007/BF02055481

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