When Should Radiation Be Avoided in the Treatment of Rectal Cancer?
The National Cancer Institute (NCI) Consensus Conference concluded in 1990 that chemotherapy plus concurrent radiation (chemoradiation) was the standard postoperative adjuvant treatment for all patients with pT3 and/or N1-2 rectal cancer . This recommendation was based on phase III trials that compared postoperative chemoradiation arms with control arms of either surgery alone or surgery plus postoperative irradiation (Mayo/NCCTG 79-47-51) and demonstrated improvements in both disease-free and overall survival . The standard design in US trials was to deliver six cycles of bolus 5-fluorouracil (5-FU)–based chemotherapy; concurrent irradiation was also given during cycles 3 and 4.
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