Skip to main content

Optimising Treatment for Resectable Rectal Cancer

Is Preoperative Therapy Beneficial?

Drugs & Aging volume 18, pages 79–85 (2001)Cite this article

Abstract

Preoperative radiotherapy is becoming the standard of care for resectable locally advanced adenocarcinoma of the rectum. Its practice is no longer limited to a few specialised cancer centres. Adjuvant preoperative radiotherapy can reduce the risk of local recurrence by 50% compared with surgery alone and it has a moderate effect in improving survival. Treatment-related toxicity is superior to that after postoperative radiotherapy. Early results of preoperative radiotherapy with concurrent chemotherapy are promising, with a low toxicity profile and a high pathological response rate. Advances in technology, endorectal ultrasound and magnetic resonance imaging enable selection of appropriate patients for preoperative radiotherapy.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

49,54 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Table I
Fig. 1
Table II
Fig. 2

References

  1. Guiney MJ, Smith JG, Woronuik V, et al. Radiotherapy treatment for isolated locoregional recurrence of recto-sigmoid carcinoma following definitive surgery. Int J Radiat Oncol Biol Phys 1997; 38: 1019–25

    PubMed  Article  CAS  Google Scholar 

  2. Shumate CR, Rich TA, Skibber JM, et al. Preoperative chemotherapy and radiation therapy for locally advanced primary and recurrent rectal carcinoma. Cancer 1993; 71: 3690–6

    PubMed  Article  CAS  Google Scholar 

  3. Leong T, Guiney M, Ngan S, et al. Preoperative radiotherapy and chemotherapy for unresectable rectal cancer. Aust NZ J Surg 1997; 67: 603–6

    Article  CAS  Google Scholar 

  4. Williams NS, Dixon MF, Johnston D. Reappraisal of the 5 centimetre rule of distal excision for carcinoma of the rectum: a study of distal intramural spread and of patients’ survival. Br J Surg 1983; 70: 150–4

    PubMed  Article  CAS  Google Scholar 

  5. Chan KW, Boey J, Wong SKC. A method of reporting radial invasion and surgical clearance of rectal carcinoma. Histopathology 1985; 9: 1319–27

    PubMed  Article  CAS  Google Scholar 

  6. Quirke P, Durdey P, Dixon MF, et al. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection: histopathological study of lateral tumour spread and surgical excision. Lancet 1986; II: 996–9

    Article  Google Scholar 

  7. Rich T, Gunderson LL, Lew R, et al. Patterns of recurrence of rectal cancer after potentially curative surgery. Cancer 1983; 52: 1317–29

    PubMed  Article  CAS  Google Scholar 

  8. Heald RJ. The ‘Holy Plane’ of rectal surgery. JR Soc Med 1988; 81: 503–8

    CAS  Google Scholar 

  9. Gastrointestinal Tumour Study Group. Prolongation of the disease-free interval in surgically treated rectal carcinoma. N Engl J Med 1985; 312: 1465–72

    Article  Google Scholar 

  10. Krook JE, Moertel CG, Gunderson LL, et al. Effective surgical adjuvant therapy for high-risk rectal carcinoma. N Engl J Med 1991; 324: 709–15

    PubMed  Article  CAS  Google Scholar 

  11. O’Connell MJ, Martenson JA, Wieand HS, et al. Improving adjuvant therapy for rectal cancer by combining protracted-infusion fluorouracil with radiation therapy after curative surgery. N Engl J Med 1994; 331: 502–7

    PubMed  Article  Google Scholar 

  12. NIH Consensus Conference. Adjuvant therapy for patients with colon and rectal cancer. JAMA 1990; 264: 1444–50

    Article  Google Scholar 

  13. Gelber RD, Goldhirsch A, Cole BF, et al. A quality-adjusted time without symptoms or toxicity (Q-TWiST) analysis of adjuvant radiation therapy and chemotherapy for resectable rectal cancer. J Natl Cancer Inst 1996; 88: 1039–45

    PubMed  Article  CAS  Google Scholar 

  14. Rich TA, Skibber JM, Ajani JA, et al. Preoperative infusional chemoradiation therapy for stage T3 rectal cancer. Int J Radiat Oncol Biol Phys 1995; 32: 1025–9

    PubMed  Article  CAS  Google Scholar 

  15. Ngan SY, Burmeister BH, Fisher R, et al. A phase II trial of preoperative radiotherapy with protracted infusion 5-fluoro-uracil for resectable adenocarcinoma of rectum: a multi-center trial for the Trans-Tasman Radiation Oncology Group. Int J Radiat Oncol Biol Phys 2000; 48 Suppl. 119–20

    Article  Google Scholar 

  16. Janjan NA, Khoo VS, Rich TA, et al. Locally advanced rectal cancer: surgical complications after infusional chemotherapy and radiation therapy. Radiology 1998; 206: 131–6

    PubMed  CAS  Google Scholar 

  17. Frykholm GJ, Glimelius B, Pahlman L. Preoperative or postoperative irradiation in adenocarcinoma of the rectum: final treatment results of a randomised trial and an evaluation of late secondary effects. Dis Colon Rectum 1993; 36: 564–72

    PubMed  Article  CAS  Google Scholar 

  18. Glimelius B, Isacsson U, Jung B, et al. Radiotherapy in addition to radical surgery in rectal cancer: evidence for a dose-response effect favoring preoperative treatment. Int J Radiat Oncol Biol Phys 1997; 37: 281–7

    PubMed  Article  CAS  Google Scholar 

  19. Grann A, Minsky BD, Cohen AM, et al. Preliminary results of preoperative 5-fluorouracil, low-dose leucovorin and concurrent radiation therapy for clinically resectable T3 rectal cancer. Dis Colon Rectum 1997; 40: 515–22

    PubMed  Article  CAS  Google Scholar 

  20. Valentini V, Coco C, Cellini N, et al. Preoperative chemoradiation with cisplatin and 5-fluorouracil for extraperitoneal T3 rectal cancer: acute toxicity, tumor response, sphincter preservation. Int J Radiat Oncol Biol Phys 1999; 45: 1175–84

    PubMed  Article  CAS  Google Scholar 

  21. Improved survival with preoperative radiotherapy in resectable rectal cancer. Swedish Rectal Cancer Trial, [published erratum appears in N Engl J Med 1997; 336: 1539]. N Engl J Med 1997; 336: 980–7

    Google Scholar 

  22. Camma C, Giunta M, Fiorica F, et al. Preoperative radiotherapy for resectable rectal cancer: a meta-analysis. JAMA 2000; 284: 1008–15

    PubMed  Article  CAS  Google Scholar 

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

    PubMed  Article  CAS  Google Scholar 

  24. Roswit B, Higgins GA, Keehn RJ. Preoperative irradiation for carcinoma of the rectum and rectosigmoid colon: report of a National Veterans Administration randomised study. Cancer 1975; 35: 1597–602

    PubMed  Article  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  26. Second Report of an MRC Working Party. The evaluation of low dose preoperative x-ray therapy in the management of operable rectal cancer: results of a randomly controlled trial. Br J Surg 1984; 71: 21–5

    Article  Google Scholar 

  27. Higgins GA, Humphrey EW, Dwight RW, et al. Preoperative radiation and surgery for cancer of the rectum. Cancer 1986; 58: 352–9

    PubMed  Article  CAS  Google Scholar 

  28. Gerard A, Buyse M, Nordlinger B, et al. Preoperative radiotherapy as adjuvant treatment in rectal cancer: final results of a randomised study of the European Organisation for Research and Treatment of Cancer (EORTC). Ann Surg 1988; 208: 606–14

    PubMed  Article  CAS  Google Scholar 

  29. Reis Neto JA, Quilici FA, Reis Jr JA. A comparison of non-operative vs. preoperative radiotherapy in rectal carcinoma: a 10-year randomised trial. Dis Colon Rectum 1989; 32: 702–10

    PubMed  Article  CAS  Google Scholar 

  30. Horn A, Halvorsen JF, Dahl O. Preoperative radiotherapy in operable rectal cancer. Dis Colon Rectum 1990; 33: 823–8

    PubMed  Article  CAS  Google Scholar 

  31. Stockholm Colorectal Cancer Study Group. Preoperative short-term radiation therapy in operable rectal carcinoma: a prospective randomised trial. Cancer 1990; 66: 49–55

    Article  Google Scholar 

  32. Goldberg PA, Nicholls RJ, Porter NH, et al. Long-term results of a randomised trial of short-course low-dose adjuvant preoperative radiotherapy for rectal cancer: reduction in local treatment failure. Eur J Cancer 1994; 30: 1602–6

    Article  Google Scholar 

  33. Marsh PJ, James RD, Schofield PF. Adjuvant preoperative radiotherapy for locally advanced rectal carcinoma: results of a prospective randomised trial. Dis Colon Rectum 1994; 37: 1205–14

    PubMed  Article  CAS  Google Scholar 

  34. Stockholm Colorectal Cancer Study Group. Randomised study on preoperative radiotherapy in rectal carcinoma. Ann Surg Oncol 1996; 3: 423–30

    Article  Google Scholar 

  35. Medical Research Council Rectal Cancer Working Party. Randomised trial of surgery alone versus radiotherapy followed by surgery for potentially operable locally advanced rectal cancer. Lancet 1996; 348: 1605–10

    Article  Google Scholar 

  36. Carlsen E, Schlichting E, Guldvog I, et al. Effect of the introduction of total mesorectal excision for the treatment of rectal cancer. Br J Surg 1998; 85: 526–9

    PubMed  Article  CAS  Google Scholar 

  37. Hildebrandt U, Feifel G. Preoperative staging of rectal cancer by intrarectal ultrasound. Dis Colon Rectum 1985; 28: 42–6

    PubMed  Article  CAS  Google Scholar 

  38. Byfield JE, Calabro-Jones P, Klisak I, et al. Pharmacologic requirements for obtaining sensitisation of human tumour cells in vitro to combined 5-fluorouracil or Ftorafur and x-rays. Int J Radiat Oncol Biol Phys 1982; 8: 1923–33

    PubMed  Article  CAS  Google Scholar 

  39. Holm T, Johansson H, Cedermark B, et al. Influence of hospital- and surgeon-related factors on outcome after treatment of rectal cancer with or without preoperative radiotherapy. Br J Surg 1997; 84: 657–63

    PubMed  Article  CAS  Google Scholar 

  40. Dahlberg M, Glimelius B, Pahlman L. Improved survival and reduction in local failure rates after preoperative radiotherapy: evidence for generalizability of the results of Swedish Rectal Cancer Trial. Ann Surg 1999; 229: 493–7

    PubMed  Article  CAS  Google Scholar 

  41. Suwinski R, Taylor JMG, Withers HR. Rapid growth of microscopic rectal cancer as a determinant of response to preoperative radiation therapy. Int J Radiat Oncol Biol Phys 1998; 42: 943–51

    PubMed  Article  CAS  Google Scholar 

  42. Sauer R, Fietkau R, Martus P, et al. Adjuvant and neoadjuvant radiochemotherapy for advanced rectal cancer: first results of the German multicenter phase III trial. Int J Radiat Oncol Biol Phys 2000; 48 Suppl.: 119

    Article  Google Scholar 

Download references

Author information

Affiliations

  1. Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia

    Samuel Y. K. Ngan

Authors
  1. Samuel Y. K. Ngan
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Ngan, S.Y.K. Optimising Treatment for Resectable Rectal Cancer. Drugs & Aging 18, 79–85 (2001). https://doi.org/10.2165/00002512-200118020-00001

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00002512-200118020-00001

Keywords

  • Rectal Cancer
  • Total Mesorectal Excision
  • Postoperative Radiotherapy
  • Preoperative Radiotherapy
  • Concurrent Chemotherapy