Skip to main content
SpringerLink
Log in

Stellenwert der Radiotherapie im multimodalen Behandlungskonzept des Rektumkarzinoms

The Role of Radiotherapy in the Multimodality Treatment of Rectal Carcinoma

  • Conference paper
Die Ambivalenz des Fortschritts — ist weniger mehr?

Part of the book series: Deutsche Gesellschaft für Chirurgie ((KONGRESSBAND,volume 1994))

  • 7 Accesses

Summary

Due to the stage-dependent, high local failure rates and their correlation to prognosis, radiotherapy was introduced as an additional local treatment approach for rectal carcinoma. With low-dose preoperative radiotherapy neither local tumor control nor prognosis was improved. Preoperative radiotherapy and especially radiochemotherapy seems to be indicated in locally advanced carcinomas to improve complete resectability. Postoperative radiotherapy alone increased local control only in nonrandomized studies, whereas in randomized studies a statistically significant improvement in both local control and death rate after simultanous radiochemotherapy was observed. This leads to the recommendation that all rectal carcinomas stage II and III should be treated with a combined approach. New radiation techniques such as three-dimensional and intraoperative radiotherapy are aimed to give maximum information about dosevolume load for normal tissues or maximum sparing of critical organs.

Zusammenfassung

Stadienbezogene hohe Lokalrezidivraten und deren strenge Korrelation zur Erkrankungsprognose führten dazu, die Radiotherapie als zusätzliche lokale Therapiemaßnahme in das Therapiekonzept einzuführen. Eine Verbesserung der lokalen Tumorkontrolle durch eine präoperative Kurzzeitradiotherapie mit niedriger Dosis konnte nicht erreicht werden. Indikationen für eine präoperative Radio- und insbesondere Radiochemotherapie hoher Dosis sind primär inoperable Karzinome, deren Rate vollständiger Resektionen deutlich erhöht werden kann. Die alleinige postoperative Radiotherapie konnte nur in nicht-randomisierten Studien eine verbesserte lokale Tumorkontrolle erwirken. Randomisierte Studien ergaben nach simultaner Radiochemotherapie eine statistisch signifikant verbesserte Tumorkontrolle und Prognose und führten zu der Empfehlung, alle Rektumkarzinome des Stadiums II und III einer kombinierten Radiochemotherapie zuzuführen. Neuere Techniken wie die dreidimensionale Bestrahlungsplanung und die intraoperative Radiotherapie sollen einerseits eine maximale Information über die Dosisbelastung kritischer Organe geben, andererseits durch direkte Bestrahlung des Tumorbettes eine maximale Schonung kritischer Organe erlauben.

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 54.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Similar content being viewed by others

Literatur

  1. Gunderson LL, Ssoin H, Levitt S (1985) Extrapelvic colon – Areas of failure in a reoperation series: Implication for adjuvant therapy. Int J Radiat One Biol Phys 11:731

    Article  CAS  Google Scholar 

  2. Mendenhall WM, Million RR, Pfaff WW (1983) Pattern of Recurrence in adenocarcinoma of the rectum and rectosigmoid treated with surgery alone: Implications in treatment planning with adjuvant radiation therapy. Int J Radiat One Biol Phys 9:977–983

    Article  CAS  Google Scholar 

  3. Rider WD, Palmer JA, Mathoney LJ, Robertson CTR (1977) Preoperative irradiation in operable cancer of the rectum: report of the Toronto trial. Can J Surg 20:335–338

    PubMed  CAS  Google Scholar 

  4. Working Party MRC, Second Report (1984) 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 71:21–35

    Article  Google Scholar 

  5. Stearns MW (1980) Pre- or postoperative radiation in resectable tumors. In: Welvaart K, Blumgart LH, Kreuning J (eds) Colorectal Cancer. Leiden University Press: 153

    Chapter  Google Scholar 

  6. Higgins GA, Conn JH, Jordan JH (1975) Preoperative radiotherapy for colorectal cancer. Ann Surg 191:624–631

    Article  Google Scholar 

  7. Roswit B, Higgins GA, Keehn J (1975) Preoperative irradiation for carcinoma of the rectum and rectosigmoid colon: Report of a national veterans administration randomized study. Cancer 35:1597–1602

    Article  PubMed  CAS  Google Scholar 

  8. Stockholm Rectal Cancer Study Group (1990) Preoperative short-term radiation therapy in operable rectal carcinoma. A prospective randomized trial. Cancer 66:49–55

    Article  Google Scholar 

  9. Higgins GA, Humphrey EW, Dwight RW, Roswit B, Lee LE, Keehn RJ (1986) Preoperative radiation and surgery for cancer of the rectum. Veterans Administration Surgical Oncology Group Trial II. Cancer 58:352–359

    Article  PubMed  CAS  Google Scholar 

  10. Gerard A, Buyse M, Nordlinger B, Loygue J, Pene F, Kempf P, Bosset JF, Gignoux M, Arnaud JP, Desaive C, Duez N (1988) Preoperative radiotherapy as adjuvant treatment in rectal cancer. Final report of a randomized study of the European Organization for Research and Treatment of Cancer (EORTC). Ann Surg 208:606–614

    Article  PubMed  CAS  Google Scholar 

  11. Pujol JA, Solassol C, Gary-Bobo J (1978) La radiothérapie préopératoire des cancer du rectum, actualisation des résultats. A propos de 179 cas. Chirurgie 104:606–611

    PubMed  CAS  Google Scholar 

  12. Reis Neto JA, Quilici FA, Reis JA Jr (1989) A comparison of non-operative vs. preoperative radiotherapy in rectal carcinoma. A 10–year randomized trial. Dis Col Rect 32:702–710

    Article  CAS  Google Scholar 

  13. Stevens KR, Fletcher WS, Allen CV (1987) Anterior resection and primary anastomosis following high dose preoperative irradiation for adenocarcinoma of the rectosigmoid. Cancer 41:2065–2071

    Article  Google Scholar 

  14. Buyse JE, Calabro-Jones P, Klisak R (1988) Adjuvant therapy of colorectal cancer. Why we still don’t know. JAMA 259:3571–3578

    Article  PubMed  CAS  Google Scholar 

  15. Mendenhall WM, Bland KI, Pfaff WW (1986) Initially unresectable rectal adenocarcinoma treated with preoperative irradiation and surgery. Ann Surg 205:1295–1302

    Google Scholar 

  16. Doseretz DE, Gunderson LL, Hedberg S, Hoskins B, Blitzer PH, Shipley W, Cohen A (1983) Preoperative irradiation for unresectable rectal and recto-sigmoid carcinoma. Cancer 52:814–818

    Article  Google Scholar 

  17. Minsky BD, Kemeny N, Cohen AM, Enker WE, Kelson DP, Reichman B, Saltz L, Sigurdson ER, Frankel J (1991) Preoperative high-dose Leucovorin/5–Fluorouracil and radiation therapy for unresectable rectal cancer. Cancer 67:2859–2866

    Article  PubMed  CAS  Google Scholar 

  18. Working Party MRC (1982) A trial of preoperative radiotherapy in the management of operable rectal cancer. Br J Surg 69:513–519

    Article  Google Scholar 

  19. Porter NH, Nicholls RJ (1985) Preoperative radiotherapy in operable rectal cancer: interim report of a trial carried out by the Rectal Cancer Group. Br J Surg 72 (Suppl): 62–64

    Article  Google Scholar 

  20. Gary-Bobo J, Pujol H, Solassol C, Broquerie JL, Nguyen M (1979) L’irradiation preoperatoire du cancer rectal. Resultats a 5 ans de 116 cas. Bull Cancer 66:491–496

    PubMed  CAS  Google Scholar 

  21. Gastrointestinal Tumor Study Group (1985) Prolongation of the disease-free interval in surgically treated rectal carcinoma. N Engl J Med 312:1465–1472

    Article  Google Scholar 

  22. Douglass HO, Moertel CG, Mayer RJ (1986) Survival after postoperative combination treatment of rectal cancer. N Engl J Med 315:1294

    Article  PubMed  Google Scholar 

  23. Fisher B, Wolmark N, Rockette H, Redmond C (1988) Postoperative adjuvant chemotherapy or radiation therapy for rectal cancer: results from NSABP Protocol R-01. J Natl Cancer Inst 80:21–29

    Article  PubMed  CAS  Google Scholar 

  24. Balslev IB, Pederson M, Teglbjaerg PS et al. (1986) Postoperative radiotherapy in Dukes B and C carcinoma of the rectum and rectosigmoid. A Randomized Multicenter Study. Cancer 58:22–28

    Article  PubMed  CAS  Google Scholar 

  25. Withers HR, Cuasay L, Mason KA, Romsdahl MM, Sacton J (1981) Elective radiation therapy in the curative treatment of cancer of the rectum and rectosigmoid. In: Stroehlein JR, Romsdahl MM (eds) Gastrointestinal cancer. Raven, New York: 351

    Google Scholar 

  26. Hoskins BR, Gunderson LL, Dosoretz DE, Rich TA, Galabini J, Donaldson G, Cohen AM (1985) Adjuvant ostoperative radiotherapy in carcinomas of the rectum and rectosigmoid. Cancer 55:61–71

    Article  PubMed  CAS  Google Scholar 

  27. Tepper JE, Cohen AM, Wood WC, Orlow E, Hedberg SE (1987) Postoperative radiation therapy of rectal cancer. Int J Radiat Oncol Biol Phys 13:5–10

    Article  PubMed  CAS  Google Scholar 

  28. Krook JE, Moertel CG, Gunderson LL, Wiand HS, Collins RT, Beart RW, Kubista TP, Poon MA, Meyers WC, Mailliard JA, Twito DI, Morton RF, Veeder MH, Witzig TE, Cha S, Vidyarthi SC (1991) Effective surgical adjuvant therapy for high-risk rectal carcinoma. N Engl J Med 324:709–715

    Article  PubMed  CAS  Google Scholar 

  29. Schild SE, Martenson JA, Gunderson LL, Ilstrup DM, Berg KK, o’Conell MJ, Weiland LH (1989) Postoperative adjuvant therapy of rectal cancer: an analysis of disease control, survival, and prognostic factors. Int J Radiat One Biol Phys 17:55–62

    Article  CAS  Google Scholar 

  30. Gallagher MJ, Brereton HD, Rostock RA, Zero JM, Zekoski DA, Poyss LF, Richter MP, Kliger- man MM (1986) A prospective study of treatment techniques to minimize the volume of pelvic small bowel with reduction of acute and late effects associated with pelvic irradiation. Int J Radiat One Biol Phys 12:1565–1573

    Article  CAS  Google Scholar 

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

    Google Scholar 

  32. Willett CG, Shellito PC (1992) Intraoperative electron beam radiation therapy for locally advanced rectal and rectosigmoid carcinoma. Strahlenther Onkol 168:490

    Google Scholar 

  33. Gunderson LL, Martenson JA, Devione RM, Wolff BG, Nivatvongs S, Pemberton JH, Beart RW (1990) Indications for and results of IORT with Colorectal Cancer. In Abe M, Takahashi M (eds) Intraoperative radiation therapy; proceedings of the third international symposium on intraoperative radiation therapy. Pergamon Press, p 299

    Google Scholar 

  34. Shaw EG, Gunderson LL, Martin JK (1990) Peripheral nerve and ureteral tolerance of intraoperative radiation therapy: clinical and dose response analysis. Radiother Oncol 18:247

    Article  PubMed  CAS  Google Scholar 

  35. Roberson E, Heron HC, Kerman HE, Bloom TS (1985) Is anterior resection of the rectosigmoid safe after preoperative radiation? Dis Colon Rectum 28:254–259

    Article  PubMed  CAS  Google Scholar 

  36. Papillon J (1982) Rectal and anal cancers. Conservative treatment by irradiation: an alternative to radical surgery. Springer, Berlin Heidelberg New York

    Google Scholar 

  37. Sischy B, Kim IS, Hinson EJ (1989) Endocavitary irradiation - ten years experience. Int J Radiat Oncol Biol Phys 10:89

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Abteilung Klinische Radiologie, Radiologische Universitätsklinik, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland

    M. F. Wannenmacher & M. J. Eble

Authors
  1. M. F. Wannenmacher
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. J. Eble
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Steinhölzle 16, D-89197, Westerstetten-Vorderdenkental, Deutschland

    W. Hartel

Rights and permissions

Reprints and permissions

Copyright information

© 1994 Springer-Verlag Berlin Heidelberg

About this paper

Cite this paper

Wannenmacher, M.F., Eble, M.J. (1994). Stellenwert der Radiotherapie im multimodalen Behandlungskonzept des Rektumkarzinoms. In: Hartel, W. (eds) Die Ambivalenz des Fortschritts — ist weniger mehr?. Deutsche Gesellschaft für Chirurgie, vol 1994. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-79242-7_73

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-79242-7_73

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-58399-8

  • Online ISBN: 978-3-642-79242-7

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation