Preoperative radiotherapy for operable rectal cancer--is a lower dose to a reduced volume acceptable?
Authors
Saunders, Mark PAlderson, H
Chittalia, Abbas
Hughes, S
James, Roger D
Armstrong, G
Swindell, Ric
Scott, N A
Affiliation
Department of Clinical Oncology, Christie Hospital, Manchester, UK. mark.saunders@christie-tr.nwest.nhs.ukIssue Date
2006-10
Metadata
Show full item recordAbstract
AIMS: A retrospective audit was carried out to determine the rate of local recurrence (recurrent tumour within the lesser pelvis or the perineal wound) in 88 rectal cancer patients treated with 20 Gy/four fractions of adjuvant preoperative radiotherapy and curative surgery. MATERIALS AND METHODS: All patients were followed-up by clinical examination with rigid sigmoidoscopy at 6 monthly intervals if the rectum was intact, and computed tomography of the pelvis at 1, 2 and 5 years after surgery. In total, 171 patients with rectal cancer were identified under the care of one surgeon over a period of 11 years from May 1992 to April 2003. We excluded patients with rectal cancer from preoperative adjuvant radiotherapy if they had evidence at presentation of distant metastases, if they had fixed rectal tumours, were treated by local excision and had previous radiotherapy to the pelvis. On this basis, only 88 were considered for preoperative radiotherapy and curative resection with a median follow-up of 5.16 years. RESULTS: The 5-year survival by stage was Dukes A 96%, Dukes B 65% and Dukes C 36%. Overall, four patients (of 88) developed a recurrence within the lesser pelvis or the perineal wound, giving a local recurrence of 4.2% at 3 years (from a Kaplan-Meier graph). CONCLUSIONS: This single-centre audit suggests that a lower dose of radiotherapy to a smaller volume provides an acceptable local recurrence rate that compares very favourably with the well-publicised Swedish and Dutch trials of 25 Gy/five fractions. It was not the intention of this audit to suggest that this dose should be widely adopted. However, given the long-term gastrointestinal morbidity and risk of second malignancies, we advise caution when formulating even more intensive radiotherapy and chemoradiotherapy regimens for rectal cancer.Citation
Preoperative radiotherapy for operable rectal cancer--is a lower dose to a reduced volume acceptable? 2006, 18 (8):594-9 Clin OncolJournal
Clinical OncologyPubMed ID
17051949Type
ArticleLanguage
enISSN
0936-6555Collections
Related articles
- Preoperative chemoradiotherapy and total mesorectal excision surgery for locally advanced rectal cancer: correlation with rectal cancer regression grade.
- Authors: Wheeler JM, Dodds E, Warren BF, Cunningham C, George BD, Jones AC, Mortensen NJ
- Issue date: 2004 Dec
- Preoperative hyperfractionated chemoradiation for locally recurrent rectal cancer in patients previously irradiated to the pelvis: A multicentric phase II study.
- Authors: Valentini V, Morganti AG, Gambacorta MA, Mohiuddin M, Doglietto GB, Coco C, De Paoli A, Rossi C, Di Russo A, Valvo F, Bolzicco G, Dalla Palma M, Study Group for Therapies of Rectal Malignancies (STORM)
- Issue date: 2006 Mar 15
- Short-term preoperative radiotherapy is a safe approach for treatment of locally advanced rectal cancer.
- Authors: Korkolis DP, Plataniotis GD, Gondikakis E, Xinopoulos D, Koulaxouzidis GV, Katsilieris J, Vassilopoulos PP
- Issue date: 2006 Jan
- Adjuvant radiation therapy for rectal carcinoma: predictors of outcome.
- Authors: Myerson RJ, Michalski JM, King ML, Birnbaum E, Fleshman J, Fry R, Kodner I, Lacey D, Lockett MA
- Issue date: 1995 Apr 30