Skip to main content

Advertisement

SpringerLink
Log in

Update on neoadjuvant strategies for rectal cancer patients

  • Published:
Current Colorectal Cancer Reports

Abstract

Neoadjuvant treatment is becoming the standard for T3-4 (distal T2) rectal adenocarcinoma. Phase III ongoing clinical trials will yield the definition of optimal concurrent chemoradiotherapy protocol. Phase II trials will test new medical treatments (targeted biotherapy) and innovative radiation technique (contact radiotherapy). Most importantly, phase II and III trials will address the question of new strategies using neoadjuvant approach to improve conservative treatment and survival rates.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Bosset JF, Collette L, Calais G, et al.: Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 2006, 355:1114–1123.

    Article  PubMed  CAS  Google Scholar 

  2. Gérard JP, Conroy T, Bonnetain F, et al.: Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers: results of FFCD 9203. J Clin Oncol 2006, 24:4620–4625.

    Article  PubMed  Google Scholar 

  3. Minsky BD, Conti JA, Huang Y, Knopf K: Relationship of acute gastrointestinal toxicity and the volume of irradiated small bowel in patients receiving combined modality therapy for rectal cancer. J Clin Oncol 1995, 13:1409–1416.

    PubMed  CAS  Google Scholar 

  4. Sauer R, Becker H, Hohenberger W, et al.: Preoperative versus postoperative radiochemotherapy for rectal cancer. N Engl J Med 2004, 351:7131–7140.

    Article  Google Scholar 

  5. Valentini V, Glimelius B, Minsky BD, et al.: The multidisciplinary rectal cancer treatment: main convergences, controversial aspects and investigational areas which support the need for an European Consensus. Radiother Oncol 2005, 76:241–250.

    Article  PubMed  Google Scholar 

  6. Hyams DM, Mamounas EP, Petrelli N, et al.: A clinical trial to evaluate the worth of preoperative multimodality therapy in patients with operable carcinoma of the rectum: a progress report of National Surgical Breast and Bowel Project Protocol R-03. Dis Colon Rectum 1997, 40:131–139.

    Article  PubMed  CAS  Google Scholar 

  7. Folkesson J, Birgisson H, Pahlman L, et al.: Swedish Rectal Cancer Trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol 2005, 23:5644–5650.

    Article  PubMed  Google Scholar 

  8. Kapiteijn E, Marijnen CA, Nagtegaal ID, et al.: Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001, 345:690–692.

    Article  Google Scholar 

  9. Sebag-Montefiore D, Steele R, Quirke P, et al.: Routine short course pre-op radiotherapy or selective post-op chemoradiotherapy for resectable rectal cancer? Preliminary results of the MRC CR 07 randomized trial. J Clin Oncol 2006, 24:148S.

    Google Scholar 

  10. Gérard JP, Chapet O, Hartweig J, et al.: Improved sphincter preservation in low rectal cancer with high-dose preoperative radiotherapy: the lyon R96-02 randomized trial. J Clin Oncol 2004, 22:2404–2409.

    Article  PubMed  Google Scholar 

  11. Faivre J, Milan C, Meny B: Risk of locoregional recurrence after resection of cancer of the rectum. Ann Chir 1994, 48:520–524.

    PubMed  CAS  Google Scholar 

  12. Bujko K, Nowacki MP, Nasierowska-Guttmejer A, et al.: Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer. Br J Surg 2006, 93:1215–1223.

    Article  PubMed  CAS  Google Scholar 

  13. Bujko K, Nowacki MP, Nasierowska-Guttmejer A, et al.: Sphincter preservation following preoperative radiotherapy for rectal cancer: report of a randomized trial comparing short-term radiotherapy vs conventionally fractionated radiochemotherapy. Radiother Oncol 2004, 72:15–24.

    Article  PubMed  CAS  Google Scholar 

  14. Ngan S, Fisher R, Burmeister BH, et al.: 55th Annual Scientific Meeting of the Royal Australian and New Zealand College of Radiologists, 21–24 October 2004, Perth, Australia [abstract]. Australas Radiol 2005, 49:1–6.

    Article  Google Scholar 

  15. Crane CH, Sargent DJ: Substitution of oral fluoropyrimidines for infusional fluorouracil with radiotherapy: how much data do we need? J Clin Oncol 2004, 22:2978–2981.

    Article  PubMed  CAS  Google Scholar 

  16. Ortholan C, Francois E, Thomas O, et al.: Role of radiotherapy with surgery for T3 and resectable T4 rectal cancer: evidence from randomized trials. Dis Colon Rectum 2006, 49:302–310.

    Article  PubMed  Google Scholar 

  17. Hida J, Yasutomi M, Tokoro T, Kubo R: Examination of nodal metastases by a clearing method supports pelvic plexus preservation in rectal cancer surgery. Dis Colon Rectum 1999, 42:510–514.

    Article  PubMed  CAS  Google Scholar 

  18. Lezoche E, Guerrieri M, Paganini AM, et al.: Long-term results in patients with T2-3 N0 distal rectal cancer undergoing radiotherapy before transanal endoscopic microsurgery. Br J Surg 2005, 92:1546–1552.

    Article  PubMed  CAS  Google Scholar 

  19. Glimelius B, Dahl O, Cedermark B, et al.: Nordic Gastrointestinal Tumour Adjuvant Therapy Group. Adjuvant chemotherapy in colorectal cancer: a joint analysis of randomised trials by the Nordic Gastrointestinal Tumour Adjuvant Therapy Group. Acta Oncol 2005, 44:904–912. Erratum in Acta Oncol 2006, 45:110.

    Article  PubMed  CAS  Google Scholar 

  20. Willett CG, Boucher Y, di Tomaso E, et al.: Direct evidence that the VEGF-specific antibody bevacizumab has antivascular effects in human rectal cancer. Nature Med 2004, 10:145–147.

    Article  PubMed  CAS  Google Scholar 

  21. Brooks S, Glynne-Jones R, Novell R, et al.: Short course continuous, hyperfractionated, accelerated radiation therapy (CHART) as preoperative treatment for rectal cancer. Acta Oncol 2006, 45:1079–1085.

    Article  PubMed  CAS  Google Scholar 

  22. Vuong T, Belliveau PJ, Michel RP, et al.: Conformal preoperative endorectal brachytherapy treatment for locally advanced rectal cancer: early results of a phase I/II study. Dis Colon Rectum 2002, 45:1486–1493; discussion 1493–1495.

    Article  PubMed  Google Scholar 

  23. MERCURY Study Group: Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study. BMJ 2006, 333:779.

    Article  Google Scholar 

  24. Habr-Gama A, Perez RO, Nadalin W, et al.: Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results. Ann Surg 2004, 240:711–717; discussion 717–718.

    PubMed  Google Scholar 

  25. Bonnen M, Crane C, Vouthey JN, et al.: Long-term results using local excision after preoperating chemoradiation among selected T3 rectal cancer patients. Int J Radiat Oncol Biology 2004, 60:1098–1105.

    Article  Google Scholar 

  26. Hershman MJ, Myint AS, Makin CA, et al.: Multi-modality approach in curative local treatment of early rectal carcinomas. Colorectal Dis 2003, 5:445–450.

    Article  PubMed  CAS  Google Scholar 

  27. Kim CJ, Yeatman TJ, Coppola D, et al.: Local excision of T2 and T3 rectal cancers after down staging chemoradiation. Ann surg 2001, 234:352–358.

    Article  PubMed  CAS  Google Scholar 

  28. Mohiuddin M, Marks G, Bannon J, et al.: High dose preoperative radiation and full thickness local excision: a new option for selected T3 distal rectal cancers. Int J Radiat Oncol Biol Phys 1994, 30:845–849.

    PubMed  CAS  Google Scholar 

  29. Ruo L, Guillem JG, Minsky BD, et al.: Preoperative radiation with or without chemotherapy and full-thickness transanal excision for selected T2 and T3 distal rectal cancers. Int J Colorectal Dis 2002, 17:54–58.

    Article  PubMed  CAS  Google Scholar 

  30. Schell SR, Zlotecki RA, Mendenhall WM, et al.: Transanal excision of locally advanced rectal cancers downstaged using neoadjuvant chemoradiotherapy. J Ann Coll Surg 2002, 194:584–591.

    Article  Google Scholar 

  31. Chau I, Brown G, Cunningham D, et al.: Neoadjuvant capecitabine and oxaliplatin followed by synchronous chemoradiation and total mesorectal excision in magnetic resonance imaging-defined poor-risk rectal cancer. J Clin Oncol 2006, 24:668–674.

    Article  PubMed  CAS  Google Scholar 

  32. Gérard JP, Arefpour A, Ginot A, et al.: The increasing place of curative-conservative treatment of rectal cancer in elderly patients. Proc ESTRO 2006. Radiother Oncol 2006, 81(Suppl 1):S321.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Centre Antoine Lacassagne, 33 Avenue de Valombrose, 06189, NICE cedex 2, France

    Jean-Pierre Gérard MD

Authors
  1. Jean-Pierre Gérard MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eric François MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jean-Pierre Gérard MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gérard, JP., François, E. Update on neoadjuvant strategies for rectal cancer patients. Curr colorectal cancer rep 3, 158–165 (2007). https://doi.org/10.1007/s11888-007-0025-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11888-007-0025-3

Keywords

Search

Navigation