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Diseases of the Colon & Rectum
Published in: Diseases of the Colon & Rectum 3/2006

01-03-2006 | Original Contributions

Role of Radiotherapy With Surgery for T3 and Resectable T4 Rectal Cancer: Evidence From Randomized Trials

Authors: Cecile Ortholan, M.D., Eric Francois, M.D., Olivier Thomas, M.D., Daniel Benchimol, Ph.D., M.D., Jacques Baulieux, M.D., Jean F. Bosset, M.D., Jean P. Gerard, M.D.

Published in: Diseases of the Colon & Rectum | Issue 3/2006

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Purpose

The main treatment for resectable rectal cancer T2–T4 N0–N2 M0 is surgery. The benefit of preoperative or postoperative radiation therapy can be analyzed in terms of improvement of local control, sphincter preservation, and survival weighted against increased toxicity.

Methods

Only randomized trials can provide strong evidence of a positive cost-benefit ratio of such combined approach. The most recent trials were reviewed.

Results

Three randomized trials, including the latest German CAO-ARO trial, have demonstrated the superiority of preoperative radiotherapy with or without chemotherapy (vs. postoperative) in terms of local control and toxicity. The Ducth TME trial showed that even with modern standard surgery, preoperative radiotherapy improved local control. Preoperative irradiation using a high dose in a small volume and a long interval before surgery may improve sphincter preservation (Lyon trials). Concurrent chemoradiation (FFCD 9203, EORTC 22921, did not significantly improve sphincter preservation or survival but significantly reduced the local recurrence rate.

Conclusions

In 2005 examination of randomized trials provides evidence for the benefit of preoperative chemoradiation in improving local control and probably sphincter preservation in rectal cancer. Randomized trials should be designed to further demonstrate improved sphincter preservation and to increase survival using adjuvant medical treatments.
Literature
1.
Heald, RJ, Moran, BJ, Ryall, RD, Sexton, R, MacFarlane, JK 1998Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978–1997Arch Surg1338949PubMed
2.
Anonymous1996Randomized trial of surgery alone versus surgery followed by radiotherapy for mobile cancer of the rectum. Medical Research Council Rectal Cancer Working PartyLancet34816101614
3.
O'Connell, MJ, Martenson, JA, Wieand, HS,  et al. 1994Improving adjuvant therapy for rectal cancer by combining protracted-infusion Fluorouracil with radiation therapy after curative surgeryN Engl J Med331502507CrossRefPubMed
4.
Colorectal Cancer Collaborative Group2001Adjuvant radiotherapy for rectal cancer: a systematic overview of 8,507 patients from 22 randomized trialsLancet35812911304
5.
Anonymous1997Improved survival with preoperative radiotherapy in resectable rectal cancer. Swedish Rectal Cancer TrialN Engl J Med336980987
6.
Camma, C, Giunta, M, Fiorica, F, Pagliaro, L, Craxi, A, Cottone, M 2000Preoperative radiotherapy for resectable rectal cancer: a meta-analysisJAMA28410081015CrossRefPubMed
7.
Frykholm, GJ, Glimelius, B, Pahlman, L 1993Preoperative or postoperative irradiation in adenocarcinoma of the rectum: final treatment results of a randomized trial and an evaluation of late secondary effectsDis Colon Rectum36564572CrossRefPubMed
8.
Pahlman, L, Glimelius, B 1990Pre or postoperative radiotherapy in rectal and rectosigmoid carcinoma. Report from a randomized multicenter trialAnn Surg211187195PubMed
9.
Hyams, DM, Mamounas, EP, Petrelli, N,  et al. 1997A clinical trial to evaluate the worth of preoperative multimodality therapy in patients with operable carcinoma of the rectum: a progress report of National Surgical Breast and Bowel Project Protocol R-03Dis Colon Rectum40131139CrossRefPubMed
10.
Sauer, R, Becker, H, Hohenberger, W,  et al. 2004Preoperative versus postoperative radiochemotherapy for rectal cancerN Engl J Med35117311740CrossRefPubMed
11.
Kapiteijn, E, Marijnen, CA, Nagtegaal, ID,  et al. 2001Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancerN Engl J Med345638646CrossRefPubMed
12.
Marijnen CA, Peeters KC, Putter H, et al. Cooperative investigators of the TME trial. Long term results, toxicity and quality of life in the TME trial. Presented at the ESTRO Meeting, Amsterdam, October 24–28, 2004, abstract 283.
13.
Marijnen, CA, Nagtegaal, ID, Klein Kranenbarg, E,  et al. 2001No downstaging after short-term preoperative radiotherapy in rectal cancer patientsJ Clin Oncol1919761984PubMed
14.
Dahlberg, M, Glimelius, B, Graf, W, Pahlman, L 1998Preoperative irradiation affects functional results after surgery for rectal cancerDis Colon Rectum41543549CrossRefPubMed
15.
Moore, HG, Riedel, E, Minsky, BD,  et al. 2003Adequacy of 1-cm distal margin after restorative rectal cancer resection with sharp mesorectal excision and preoperative combined-modality therapyAnn Surg Oncol108085CrossRefPubMed
16.
Francois, Y, Nemoz, CJ, Baulieux, J,  et al. 1999Influence of the interval between preoperative radiation therapy and surgery on downstaging and on the rate of sphincter-sparing surgery for rectal cancer: the Lyon R90-01 randomized trialJ Clin Oncol172396PubMed
17.
Pollack, A, Zagars, GK, Starkschall, G,  et al. 2002Prostate cancer radiation dose response: results of the M.D. Anderson phase III randomized trialInt J Radiat Oncol Biol Phys5310971105PubMed
18.
Romestaing, P, Lehingue, Y, Carrie, C,  et al. 1997Role of a 10-Gy boost in the conservative treatment of early breast cancer: results of a randomized trial in Lyon, FranceJClin Oncol15963968
19.
Gerard, JP, Chapet, O, Ramaioli, A, Romestaing, P 2002Long-term control of T2–T3 rectal adenocarcinoma with radiotherapy aloneInt J Radiat Oncol Biol Phys54142149PubMed
20.
Gerard, JP, Chapet, O, Nemoz, C,  et al. 2004Improved sphincter preservation in low rectal cancer with high-dose preoperative radiotherapy: the LYON R96-02 randomized trialJ Clin Oncol2224042409CrossRefPubMed
21.
Minsky, B, Cohen, A, Enker, W,  et al. 1994Preoperative 5 fluorouracil, low-dose leucovorin, and concurrent radiation therapy for rectal cancerCancer73273280PubMed
22.
Bosset, JF, Magnin, V, Maingon, P,  et al. 2000Preoperative radiochemotherapy in rectal cancer: long-term results of a phase II trialInt J Radiat Oncol Biol Phys46323327CrossRefPubMed
23.
Garcia-Aguilar, J, Hernandez de Anda, E, Sirivongs, P, Lee, SH, Madoff, RD, Rothenberger, DA 2003A pathologic complete response to preoperative chemoradiation is associated with lower local recurrence and improved survival in rectal cancer patients treated by mesorectal excisionDis Colon Rectum46298304PubMed
24.
Valentini, V, Coco, C, Cellini, N,  et al. 1998Preoperative chemoradiation for extraperitoneal T3 rectal cancer: acute toxicity, tumor response, and sphincter preservationInt J Radiat Oncol Biol Phys4010671075CrossRefPubMed
25.
Crane, CH, Skibber, JM, Feig, BW,  et al. 2003Response to preoperative chemoradiation increases the use of sphincter-preserving surgery in patients with locally advanced low rectal carcinomaCancer97517524CrossRefPubMed
26.
Bosset, JF, Calais, G, Daban, A,  et al. 2004Preoperative chemoradiotherapy versus preoperative radiotherapy in rectal cancer patients: assessment of acute toxicity and treatment compliance. Report of the 22921 randomised trial conducted by the EORTC Radiotherapy GroupEur J Cancer40219224CrossRefPubMed
27.
Bosset JF, Calais G, Mineur L, et al. Preoperative radiation (preoperative RT) in rectal cancer: effect and timing of additional chemotherapy (CT) 5-year results of the EORTC 22921 trial. Oral presentation. Proceedings of ASCO 2005, Orlando, Florida, May 13–17, 2005;23(16s):247s (abstract 3505).
28.
Gerard JP, Bonnetain F, Conroy T, et al. Preoperative (preop) radiotherapy (RT) +/− 5FU/folinic acid (FA) in T3–4 rectal cancers: results of the FFCD 9203 randomized trial. Oral presentation. Proceedings of ASCO 2005, Orlando, Florida, May 13–17, 2005;23(16s):247s (abstract 3504).
29.
Bujko, K, Nowacki, MP, Nasierowska-Guttmejer, A,  et al. 2004Sphincter preservation following preoperative radiotherapy for rectal cancer: report of a randomized trial comparing short-term radiotherapy vs. conventionally fractionated radiochemotherapyRadiother Oncol721524CrossRefPubMed
30.
Freyer, G, Bossard, N, Romestaing, P,  et al. 2001Addition of oxaliplatin to continuous fluorouracil, l-folinic acid, and concomitant radiotherapy in rectal cancer: the Lyon R 97-03 phase I trialJ Clin Oncol1924332438PubMed
31.
Gerard, JP, Chapet, O, Nemoz, C,  et al. 2003Preoperative concurrent chemoradiotherapy in locally advanced rectal cancer with high-dose radiation and oxaliplatin-containing regimen: The Lyon R0-04 phase II trialJ Clin Oncol2111191124CrossRefPubMed
32.
Glynne-Jones R, Sebag-Montefiore D, McDonald A, Falk S, Maughan T. Preliminary phase II SOCRATES study results: Capecitabine combined with oxaliplatin and preoperative radiation in patients with locally advanced rectal cancer. Proceedings of ASCO 2004, New Orleans, Louisiana, June 5–8, 2004;22(14s):263s (abstract 3575).
33.
Rodel, C, Grabenbauer, GG, Papadopoulos, T, Hohenberger, W, Schmoll, HJ, Sauer, R 2003Phase I/II trial of capecitabine, oxaliplatin, and radiation for rectal cancerJ Clin Oncol2130983104CrossRefPubMed
34.
Willett, CG, Boucher, Y, Tomaso, E,  et al. 2004Direct evidence that the VEGF-specific antibody bevacizumab has antivascular effects in human rectal cancerNat Med10145147PubMed
35.
Gray RG, Barnwell J, Hills R, McConkey C, Williams N, Kerr D, for the QUASAR Collaborative Group. QUASAR: A randomized study of adjuvant chemotherapy vs. observation including 3238 colorectal cancer patients. Proceedings of ASCO 2004, New Orleans, Louisiana, June 5–8, 2004 (abstract 3501).
36.
James, RD Donaldson, D Gray, R Northover, JM Stenning, SP Taylor, I AXIS Collaborators2003Randomized clinical trial of adjuvant radiotherapy and 5 fluorouracil infusion in colorectal cancer (AXIS)Br J Surg9012001212PubMed
Metadata
Title
Role of Radiotherapy With Surgery for T3 and Resectable T4 Rectal Cancer: Evidence From Randomized Trials
Authors
Cecile Ortholan, M.D.
Eric Francois, M.D.
Olivier Thomas, M.D.
Daniel Benchimol, Ph.D., M.D.
Jacques Baulieux, M.D.
Jean F. Bosset, M.D.
Jean P. Gerard, M.D.
Publication date
01-03-2006
Publisher
Springer-Verlag
Published in
Diseases of the Colon & Rectum / Issue 3/2006
Print ISSN: 0012-3706
Electronic ISSN: 1530-0358
DOI
https://doi.org/10.1007/s10350-005-0263-x

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