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International Journal of Colorectal Disease

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01-01-2006 | Original Article

Short-term preoperative radiotherapy is a safe approach for treatment of locally advanced rectal cancer

Authors: D. P. Korkolis, G. D. Plataniotis, E. Gondikakis, D. Xinopoulos, G. V. Koulaxouzidis, J. Katsilieris, P. P. Vassilopoulos

Published in: International Journal of Colorectal Disease | Issue 1/2006

Abstract

Background and aims

The Swedish Rectal Cancer Trial (SRCT) demonstrated that a short term regimen of high-dose preoperative radiotherapy (5×5 Gy) not only reduces the risk of local recurrence but also improves overall survival rate. An increase in postoperative mortality and morbidity has also been observed, however. We therefore evaluated early postoperative complications in patients treated with neoadjuvant radiotherapy for locally advanced rectal adenocarcinoma.

Patients/methods

Between 2000 and 2004, 85 patients with locally advanced rectal tumors were treated in our institution. Preoperative staging was based on CT scan and, in several cases, on endorectal ultrasonography. They were 55 men and 30 women, with a median age of 68 years. They were retrospectively divided into two groups: Group A, which included 40 patients undergoing preoperative radiotherapy (25 Gy in five fractions) followed by surgery within 1 week, and Group B, which included 45 patients with rectal cancer receiving surgery immediately after diagnosis. Both groups were homogeneous regarding age, gender and preoperative stage of the disease. The two groups were compared for both technical difficulties during operation and rate of postoperative complications.

Results/findings

No postoperative deaths were recorded in either group. Low anterior resection with total mesorectal excision was performed in all group A patients, whereas eight patients in group B underwent abdominoperineal resection (P<0.05). Diverting stoma was performed in seven patients of group A and it was closed 3–6 months later on every occasion. Postoperative morbidity was not statistically significant between the two groups (40 vs 39%). The rate of postoperative hemorrhage, pelvic or abdominal wound infection, acute urinary infection, and delayed ileus was similar. The percentage of major anastomotic leak was also equivalent (5 vs 6.6%).

Interpretation/conclusion

Short-term preoperative radiotherapy does not increase the rate of postoperative complications and is a safe therapeutic adjunct for the treatment of locally advanced rectal cancer.

Kapiteijn E, Marijnen CA, Colenbrander AC et al (1998) Local recurrence in patients with rectal cancer diagnosed between 1988 and 1992: a population-based study in the West Netherlands. Eur J Surg Cancer 24:528–535CrossRef

Martling AL, Holm T, Rutqvist LE et al (2000) Effect of a surgical training program on outcome of rectal cancer in the County of Stockholm. Stockholm Colorectal Cancer Study Group, Basingstoke Bowel Cancer Research Project. Lancet 356:93–96CrossRefPubMed

Enker WE (1997) Total mesorectal excision—the new golden standard of surgery for rectal cancer. Ann Med 29:127–133PubMed

Sauer R (2002) Adjuvant and neoadjuvant radiotherapy and concurrent radiochemotherapy for rectal cancer. Pathol Oncol Res 8(1):7–17PubMed

Willet CG, Badizadegan K, Ancukiewicz M et al (1999) Prognostic factors in stage T3N0 rectal cancer. Do all patients require postoperative pelvic irradiation and chemotherapy? Dis Colon Rectum 42:167–173PubMed

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

Goldberg PA, Nicholls RJ, Porter NH et al (1994) Long-term results of a randomized trial of short-course low-dose preoperative radiotherapy for rectal cancer: reduction in local treatment failure. Eur J Cancer 30A:1602–1606

Stockholm Colorectal Cancer Study Group (1996) Randomized study on preoperative radiotherapy in rectal carcinoma. Ann Surg Oncol 3:423–430

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

10.

International Commission on Radiation Units and Measurement Report 50 (1993) Prescribing, recording, and reporting photon beam therapy. International Commission on Radiation Units, Bethesda, MD

11.

Heald RJ (1995) Rectal cancer: the surgical options. Eur J Cancer 31A:1189–1192

12.

Pahlman L (2000) Neoadjuvant and adjuvant radio- and radio-chemotherapy of rectal carcinomas. Int J Colorectal Dis 15:1–8CrossRefPubMed

13.

Minsky BD (1997) Adjuvant therapy for rectal cancer—a good first step [letter]. N Engl J Med 14:1016–1017CrossRef

14.

Kapiteijn E, Marijnen CAM, Nagtegaal ID et al (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345:638–646CrossRefPubMed

15.

Marijnen CAM, Kapiteijn E, Van de Velde CJH et al (2002) Acute side effects and complications after short-term preoperative radiotherapy combined with total mesorectal excision in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol 20:817–825CrossRefPubMed

16.

Sauer R, Fietkau R, Wittekind C et al (2001) Adjuvant versus neoadjuvant radiochemotherapy for locally advanced rectal cancer. A progress report of a phase-III randomized trial (protocol CAO/ARO/AIO-94). Strahlenther Onkol 117:173–218

17.

Dahlberg M, Glimelius B, Graf W et al (1998) Preoperative irradiation affects functional results after surgery for rectal cancer. Dis Colon Rectum 41:543–551PubMed

18.

Allal AS, Bieri S, Brundler MA et al (2002) Preoperative hyperfractionated radiotherapy for locally advanced rectal cancers: a phase I–II trial. Int J Radiat Oncol Biol Phys 54(4):1076–1081CrossRefPubMed

19.

Cedermark B, Johansson H, Rutqvist LE et al (1995) The Stockholm I trial of preoperative short-term radiotherapy in operable rectal carcinoma: a prospective randomized trial. Stockholm Colorectal Cancer Study Group. Cancer 75:2269–2275

20.

Valero G, Lujan JA, Hernandez Q et al (2003) Neoadjuvant radiation and chemotherapy in rectal cancer does not increase postoperative complications. Int J Colorectal Dis 18(6):495–499CrossRefPubMed

21.

Swedish Rectal Cancer Trial (1993) Initial report from a Swedish multicenter study examining the role of preoperative irradiation in the treatment of patients with resectable rectal carcinoma. Br J Surg 80:1333–1336

22.

Poon RT, Chu KW, Ho JW et al (1999) Prospective evaluation of defunctioning stoma for low anterior resection with total mesorectal excision. World J Surg 23:463–467PubMed

23.

Law WI, Chu KW, Ho JW et al (2000) Risk factors for anastomotic leakage after low anterior resection with total mesorectal excision. Am J Surg 179:92–96CrossRefPubMed

24.

Carlsen E, Schlichting E, Guldvog I et al (1998) Effect of the introduction of total mesorectal excision for the treatment of rectal cancer. Br J Surg 85:526–529CrossRefPubMed

25.

Karanjia ND, Corder AP, Bearn P et al (1994) Leakage from stapled low anastomosis after total mesorectal excision for carcinoma of the rectum. Br J Surg 81:1224–1226PubMed

26.

Medical Research Council Rectal Cancer Working Party (1996) Randomized trial of surgery alone versus radiotherapy followed by surgery for potentially operable locally advanced rectal cancer. Lancet 348:1605–1610

27.

Pucciarelli S, Toppan P, Friso ML et al (1999) Preoperative combined radiotherapy and chemotherapy for rectal cancer does not affect early postoperative morbidity and mortality in low anterior resection. Dis Colon Rectum 42(10):1276–1283PubMed

Title: Short-term preoperative radiotherapy is a safe approach for treatment of locally advanced rectal cancer
Authors: D. P. Korkolis
G. D. Plataniotis
E. Gondikakis
D. Xinopoulos
G. V. Koulaxouzidis
J. Katsilieris
P. P. Vassilopoulos
Publication date: 01-01-2006
Publisher: Springer-Verlag
Published in: International Journal of Colorectal Disease / Issue 1/2006
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-005-0740-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Short-term preoperative radiotherapy is a safe approach for treatment of locally advanced rectal cancer

Abstract

Background and aims

Patients/methods

Results/findings

Interpretation/conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background and aims

Patients/methods

Results/findings

Interpretation/conclusion

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