Preoperative radiotherapy for operable rectal cancer--is a lower dose to a reduced volume acceptable?

4.60
Hdl Handle:
http://hdl.handle.net/10541/72576
Title:
Preoperative radiotherapy for operable rectal cancer--is a lower dose to a reduced volume acceptable?
Authors:
Saunders, Mark P; Alderson, H; Chittalia, Abbas; Hughes, S; James, Roger D; Armstrong, G; Swindell, Ric; Scott, N A
Abstract:
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.
Affiliation:
Department of Clinical Oncology, Christie Hospital, Manchester, UK. mark.saunders@christie-tr.nwest.nhs.uk
Citation:
Preoperative radiotherapy for operable rectal cancer--is a lower dose to a reduced volume acceptable? 2006, 18 (8):594-9 Clin Oncol
Journal:
Clinical Oncology
Issue Date:
Oct-2006
URI:
http://hdl.handle.net/10541/72576
PubMed ID:
17051949
Type:
Article
Language:
en
ISSN:
0936-6555
Appears in Collections:
All Christie Publications

Full metadata record

DC FieldValue Language
dc.contributor.authorSaunders, Mark P-
dc.contributor.authorAlderson, H-
dc.contributor.authorChittalia, Abbas-
dc.contributor.authorHughes, S-
dc.contributor.authorJames, Roger D-
dc.contributor.authorArmstrong, G-
dc.contributor.authorSwindell, Ric-
dc.contributor.authorScott, N A-
dc.date.accessioned2009-07-06T11:32:34Z-
dc.date.available2009-07-06T11:32:34Z-
dc.date.issued2006-10-
dc.identifier.citationPreoperative radiotherapy for operable rectal cancer--is a lower dose to a reduced volume acceptable? 2006, 18 (8):594-9 Clin Oncolen
dc.identifier.issn0936-6555-
dc.identifier.pmid17051949-
dc.identifier.urihttp://hdl.handle.net/10541/72576-
dc.description.abstractAIMS: 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.en
dc.language.isoenen
dc.subjectCancer Recurrenceen
dc.subjectRectal Canceren
dc.subject.meshAdenocarcinoma-
dc.subject.meshAged-
dc.subject.meshFemale-
dc.subject.meshFollow-Up Studies-
dc.subject.meshHumans-
dc.subject.meshKaplan-Meiers Estimate-
dc.subject.meshMale-
dc.subject.meshMiddle Aged-
dc.subject.meshNeoplasm Recurrence, Local-
dc.subject.meshPreoperative Care-
dc.subject.meshRadiotherapy Dosage-
dc.subject.meshRadiotherapy, Adjuvant-
dc.subject.meshRectal Neoplasms-
dc.subject.meshRetrospective Studies-
dc.titlePreoperative radiotherapy for operable rectal cancer--is a lower dose to a reduced volume acceptable?en
dc.typeArticleen
dc.contributor.departmentDepartment of Clinical Oncology, Christie Hospital, Manchester, UK. mark.saunders@christie-tr.nwest.nhs.uken
dc.identifier.journalClinical Oncologyen

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