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Neoadjuvant Radiotherapy and Radiochemotherapy for Rectal Cancer

  • Conference paper
Rectal Cancer Treatment

Part of the book series: Recent Results in Cancer Research ((RECENTCANCER,volume 165))

Abstract

Combined radiochemotherapy is the recommended standard postoperative therapy for patients with stage II and III rectal cancer in the USA and in Germany. During the last decade, substantial progress has been made in treatment modalities: surgical management currently includes a broad spectrumof operative procedures ranging from radical operations such as abdominoperineal resections to innovative sphincter-preserving techniques. Specialized groups have reported excellent local control rates with total mesorectal excision (TME) alone without the addition of neoadjuvant or adjuvant treatment. New and improved radiation techniques using conformal radiotherapy as well as innovative chemotherapy schedules and combinations (capecitabine, oxaliplatin, irinotecan) of chemotherapy may have the potential to further increase the therapeutic benefit of (neo-)adjuvant treatment. Moreover, the basic issue of timing of radiotherapy—preoperative versus postoperative—within a multimodality regimen is currently being addressed in prospective trials. Evidently, the current monolithic approach established by studies conducted more than a decade ago, to either apply the same schedule of postoperative radiochemotherapy to all patients with UICC stage II and III rectal cancer or to give preoperative short-course radiation according to the Swedish concept for all patients with resectable rectal cancer irrespective of tumor stage and treatment goal (e.g., sphincter preservation), need to be questioned.

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References

  • Beets-Tan RGH, Beets GL, Vliegen RFA et al (2001) Accuracy of magnetic resonance imaging in prediction of tumor-free resection margins in rectal cancer surgery. Lancet 357:497–504

    PubMed  Google Scholar 

  • Camma C, Giunta M, Fiorica F et al (2000) Preoperative radiotherapy for resectable rectal cancer. A meta-analysis. JAMA 248:1008–1015

    Article  Google Scholar 

  • Chan A, Wong A, Langevin J et al (1993) Preoperative concurrent 5-fluorouracil infusion, mitomycin C and pelvic radiation therapy in tethered and fixed rectal carcinoma. Int J Radiat Oncol Biol Phys 25:791–799

    PubMed  Google Scholar 

  • Enker WE (1997) Totalmesorectal excision—the new golden standard of surgery for rectal cancer Ann Med 29:127–133

    PubMed  Google Scholar 

  • François Y, Nemoz CJ, Baulieux J et al (1999) Influence of the interval between preoperative radiation therapy and surgery on downstaging and the rate of sphincter-sparing surgery for rectal cancer: the Lyon R90-01 randomized trial. J Clin Oncol 17:2396–2402

    PubMed  Google Scholar 

  • Frykholm GJ, Glimelius B, Pahlman L (1993) Preoperative or postoperative irradiation in adenocarcinoma of the rectum: final treatment results of a randomized trial and an evaluation of late secondary effects. Dis Colon Rectum 36:564–572

    Article  PubMed  Google Scholar 

  • Frykholm GJ, Pahlman L, Glimelius B (2001) Combined chemo-and radiotherapy vs. radiotherapy alone in the treatment of primary, nonresectable adenocarcinoma of the rectum. Int J Radiat Oncol Biol Phys 50:427–434

    Article  PubMed  Google Scholar 

  • Grann A, Minsky BD, Cohen AM et al (1997) Preliminary results of preoperative 5-fluorouracil (5-FU), low dose leucovorin, and concurrent radiation therapy for resectable T3 rectal cancer. Dis Colon Rectum 40:515–522

    Article  PubMed  Google Scholar 

  • Gunderson LL, Sargent DJ, Tepper JE et al (2002) Impact of T and N substages on survival and disease relapse in adjuvant rectal cancer: a pooled analysis. Int J Radiat Oncol Biol Phys 54:386–396

    Article  PubMed  Google Scholar 

  • Hyams DM, Mamounas EP, Petrelli N et al (1997) A clinical trial to evaluate the worth of preoperative multimodality therapy in patients with operable carcinoma of the rectum: a progress report of NSABP R-03. Dis Colon Rectum 40:131–139

    Article  PubMed  Google Scholar 

  • Junginger T, Hossfeld DK, Sauer R, Hermanek P (1999): Adjuvante Therapie bei Kolon-und Rektumkarzinom. Dt Ärztebl 96:698–700

    Google Scholar 

  • Kapiteijn E, Marijnen CAM, Nagtegaal ID et al (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345:638–648

    PubMed  Google Scholar 

  • Maghfoor I, Wilkes J, Kuvshinoff B et al (1997) Neoadjuvant chemoradiotherapy with sphinctersparing surgery for low lying rectal cancer (abstract). Proc Am Soc Clin Oncol 1997;16:274

    Google Scholar 

  • Mannerts GH, Martijn H, Crommelin MA et al (2000) Feasibility and first results of multimodality treatment, combining EBRT, extensive surgery, and IORT in locally advanced primary rectal cancer. Int J Radiat Oncol Biol Phys 47:425–433

    Article  PubMed  Google Scholar 

  • Marijnen CAM, Nagtegaal ID, Klein Kranenbarg E et al (2001) No downstaging after short-term preoperative radiotherapy in rectal cancer patients. J Clin Oncol 19:1976–1984

    PubMed  Google Scholar 

  • Marijnen CAM, Nagtegaal ID, Kapiteijn E et al (2003) Radiotherapy does not compensate for positive resection margins in rectal cancer patients: report of amulticenter randomized trial. Int J Radiat Oncol Biol Phys 55:1311–1320

    Article  PubMed  Google Scholar 

  • Marsh RD, Chu NM, Vauthey JN et al (1996) Preoperative treatment of patients with locally advanced unresectable rectal adenocarcinoma utilizing continuous chronobiologically shaped 5-fluorouracil infusion and radiation therapy. Cancer 78:217–225

    Article  PubMed  Google Scholar 

  • Minsky BD (2002). Cancer of the colon, rectum and anus. ASTRO-refresher course 2002, Course Nr. 211

    Google Scholar 

  • Minsky BD, Cohen AM, Kemeny N et al (1992) Enhancement of radiation induced downstaging of rectal cancer by fluorouracil and high-dose leucovorin chemotherapy. J Clin Oncol 10:79–84

    PubMed  Google Scholar 

  • Nagtegaal ID, van Kriegen JHJM (2002). The role of pathologists in the quality control of diagnosis and treatment of rectal cancer—an overview. Eur J Cancer 38:964–972

    Google Scholar 

  • NIH Consensus Conference (1990) Adjuvant therapy for patients with colon and rectal cancer. JAMA 264:1444–1450

    Google Scholar 

  • Rau B, Wust P, Gellermann J et al (1998) Preoperative radio-chemo-thermo-therapy in locally advanced rectal cancer. Strahlenther Onkol 174:556–565

    PubMed  Google Scholar 

  • Rödel C, Sauer R (2001) Perioperative radiotherapy and concurrent radiochemotherapy in rectal cancer. Semin Surg Oncol 20:3–12

    Article  PubMed  Google Scholar 

  • Rödel C, Grabenbauer GG, Schick CH et al (2000) Preoperative radiation with concurrent 5-fluorouracil for locally advanced T4-primary rectal cancer. Strahlenther Onkol 176:161–167

    Article  PubMed  Google Scholar 

  • Rödel C, Grabenbauer GG, Papadopoulos T et al (2003) Phase III trial of capecitabine, oxaliplatin, and radiation for rectal cancer. J Clin Oncol 21:3098–3104

    Article  PubMed  Google Scholar 

  • Roh MS, Petrelli N, Colangelo L et al (2001) Phase III randomized trial of preoperative versus postoperative multimodality therapy in patients with carcinoma of the rectum (NSABP R-03) (abstract). Proc Am Soc Clin Oncol 20:123a

    Google Scholar 

  • Rouanet P, Fabre JM, Dubois JB (1995) Conservative surgery for low rectal carcinoma after high-dose radiation. Ann Surg 221:67–73

    PubMed  Google Scholar 

  • Sauer R for the German Rectal Cancer Study Group (2003) Adjuvant versus neoadjuvant combined modality treatment for locally advanced rectal cancer: first results of the German rectal cancer study (abstract 2). Int J Radiat Oncol Biol Phys 57:124

    Google Scholar 

  • Swedish Rectal Cancer Trial (1997) Improved survival with preoperative radiotherapy in resectable rectal cancer. New Engl J Med 336:980–987

    Google Scholar 

  • Valentini V, Coco C, Cellini N et al (1998) Preoperative chemoradiation for extraperitoneal T3 rectal cancer: acute toxicity, tumor response, and sphincter preservation. Int J Radiat Oncol Biol Phys 40:1067–1072

    Article  PubMed  Google Scholar 

  • Van de Velde CJH (2002). Preoperative radiotherapy and TME-surgery for rectal cancer: detailed analysis in relation to quality control in a randomized trial (abstract). Proc Am Soc Clin Oncol 21:127a

    Google Scholar 

  • Videtic GM, Fisher BJ, Perera FE et al (1998) Preoperative radiation with concurrent 5-fluorouracil continuous infusion for locally advanced unresectable rectal cancer. Int J Radiat Oncol Biol Phys 42:319–324

    Article  PubMed  Google Scholar 

  • Wagman R, Minsky BD, Cohen AM et al (1998) Sphincter preservation with preoperative radiation therapy and coloanal anastomosis: long tern follow-up. Int J Radiat Oncol Biol Phys 42:51–57

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiation Therapy, University of Erlangen-Nürnberg, Universitätsstr. 27, 91054, Erlangen, Germany

    Claus Rödel

Authors
  1. Claus Rödel
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  2. Rolf Sauer
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Editors and Affiliations

  1. Abteilung für Allgemeine, Viszerale, Unfallchirurgie und Poliklinik, Chirurgische Universitätsklinik Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Markus W. Büchler  & Jürgen Weitz  & 

  2. Chirurgie, Krankenhaus Gerresheim, Kliniken der Landeshauptstadt, Gräulinger Straße 120, 40625, Düsseldorf, Germany

    Bernward Ulrich

  3. The Pelican Cancer Foundation, North Hampshire Hospital, Basingstoke, Hampshire, RG24 9NA, UK

    Richard John Heald (OBE, Surgical Director) (OBE, Surgical Director)

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© 2005 Springer-Verlag Berlin Hidelberg

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Rödel, C., Sauer, R. (2005). Neoadjuvant Radiotherapy and Radiochemotherapy for Rectal Cancer. In: Büchler, M.W., Weitz, J., Ulrich, B., Heald, R.J. (eds) Rectal Cancer Treatment. Recent Results in Cancer Research, vol 165. Springer, Berlin, Heidelberg. https://doi.org/10.1007/3-540-27449-9_24

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  • DOI: https://doi.org/10.1007/3-540-27449-9_24

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-23341-1

  • Online ISBN: 978-3-540-27449-0

  • eBook Packages: MedicineMedicine (R0)

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