Top

International Journal of Colorectal Disease

Published in:

01-01-2010 | Original Article

Modified neoadjuvant short-course radiation therapy in uT3 rectal carcinoma: low local recurrence rate with unchanged overall survival and frequent morbidity

Authors: Rainer Kube, Henry Ptok, David Jacob, Jörg Fahlke, Pawel Mroczkowski, Hans Lippert, Gunther Ziegenhardt, Uwe Schmidt, Ingo Gastinger

Published in: International Journal of Colorectal Disease | Issue 1/2010

Abstract

Purpose

The purpose of this study is to investigate the value of a modified neoadjuvant short-course radiation therapy (SCRT) in uT3 rectal carcinoma, which, despite local R0 resectability, carries a greater risk of local recurrence than less invasive carcinomas.

Methods

Sixty-three patients with uT3 rectal carcinoma ≤10 cm above the anal verge received a modified 8 × 3 Gy pre-operative SCRT. Radiation-associated and peri-operative complications were recorded, and the patients were followed up for long-term oncological outcome and morbidity.

Results

In the study group, there were no severe adverse radiation-associated effects; the rate of peri-operative morbidity was 54.0% and that of in-hospital mortality is 4.8%. The probability (Kaplan–Meier estimate) of local recurrence was 3.9% with a probability of metachronic distant metastases of 26.8% (5-year rates). We found the probability of 5-year disease-free survival to be 70.5% and that of 5-year overall survival, 59.5%. Long-term complications were reported for 31.7% of patients.

Conclusions

Compared to the literature-modified 8 × 3 Gy neoadjuvant SCRT and surgery in uT3, rectal carcinoma was associated with low local recurrence but frequent peri-operative complications. The decisive prognostic factor, distant metastasis, was unaffected. Difficulties included overestimation of tumour invasion depth by endosonography. Possible clinical consequences of the results are discussed.

Heald B (2006) Better surgery and better selection for adjuvants—still the key to improving outcomes in rectal cancer. Acta Chir Iugosl 53:35–37PubMedCrossRef

Hermanek P, Heald RJ (2004) Pre-operative radiotherapy for rectal carcinoma? Has the case really been made for short course pre-operative radiotherapy if surgical standards for rectal carcinoma are optimal? Colorectal Dis 6:288–289CrossRef

Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, Fietkau R, Martus P, Tschmelitsch J, Hager E, Hess CF, Karstens JH, Liersch T, Schmidberger H, Raab R, The German Rectal Cancer Study Group (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740CrossRefPubMed

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

Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, Rutten HJ, Påhlman L, Glimelius B, van Krieken JH, Leer JW, van de Velde CJ, Dutch Colorectal Cancer Group (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345:638–646CrossRefPubMed

Brooks S, Glynne-Jones R, Novell R, Harrison M, Brown K, Makris A (2006) Short course continuous, hyperfractionated, accelerated radiation therapy (CHART) as preoperative treatment for rectal cancer. Acta Oncol 45:1079–1085CrossRefPubMed

Widder J, Herbst F, Dobrowsky W, Schmid R, Pokrajac B, Jech B et al (2005) Preoperative short-term radiation therapy (25 Gy, 2.5 Gy twice daily) for primary resectable rectal cancer (phase II). Br J Cancer 92:1209–1214CrossRefPubMed

Colorectal Cancer Collaborative Group (2001) Adjuvant radiotherapy for rectal cancer: a systematic overview of 8507 patients from 22 randomised trials. Lancet 358:1291–1304CrossRef

Lippert H, Gastinger I (2006) Versorgung von Patienten mit Rektumkarzinomen in Deutschland [Medical Care of Patients with Rectal Carcinoma in Germany]. Dtsch Arztebl 103:A2704–A2709

10.

Ptok H, Marusch F, Kuhn R, Gastinger I, Lippert H (2007) Influence of hospital volume on the frequency of abdominoperineal resection and long-term oncological outcomes in low rectal cancer. Eur J Surg Oncol 33:854–861PubMed

11.

Ulrich A, Schwerdt J, Z’graggen K, Kienle P, Weitz J, Büchler MW (2007) Acceptance of neoadjuvant short-term radiotherapy: a survey under surgeons and radiotherapists. Langenbeck’s Arch Surg 392:525–533CrossRef

12.

Kornmann M, Henne-Bruns D (2008) Qualität der Datengrundlage zu Evidence-based-Medicine - Rektumkarzinom und präoperative 5 × 5 Bestrahlung [Quality for the data basis of evidence-based medicine: rectal cancer and preoperative 5 × 5 irradiation]. Zentralbl Chir 133:20–24CrossRefPubMed

13.

Folkesson J, Birgisson H, Påhlman L, Cedermark B, Glimelius B, Gunnarsson U (2005) Swedish Rectal Cancer Trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol 23:5644–5650CrossRefPubMed

14.

Pieterse AH, Stiggelbout AM, Baas-Thijssen MC, van de Velde CJ, Marijnen CA (2007) Benefit from preoperative radiotherapy in rectal cancer treatment: disease-free patients’ and oncologists’ preferences. Br J Cancer 97:717–724CrossRefPubMed

15.

Siegel R, Dresel S, Koswig S, Gebauer B, Hünerbein M, Schneider W, Schlag PM (2008) Response to preoperative short-course radiotherapy in locally advanced rectal cancer: value of f-fluorodeoxyglucose positron emission tomography. Onkologie 31:166–172CrossRefPubMed

16.

Ulrich A, Weitz J, Friess H, Büchler M (2006) Fiktion und Fakten bei der multimodalen Therapie des Rektumkarzinoms [Fiction and facts about multi-modal therapy in rectal cancer]. Zentralbl Chir 131:134–139CrossRefPubMed

17.

Bujko K, Nowacki MP, Nasierowska-Guttmejer A, Michalski W, Bebenek M, Kryj M, for the Polish Colorectal Cancer Group (2006) Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer. Br J Surg 93:1215–1223CrossRefPubMed

18.

Marijnen CA, Kapiteijn E, van de Velde CJ, Martijn H, Steup WH, Wiggers T, Kranenbarg EK, Leer JW, the Cooperative Investigators of the Dutch Colorectal Cancer Group (2002) Acute side effects and complications after short-term preoperative radiotherapy combined with total mesorectum excision in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol 20:817–825CrossRefPubMed

19.

van der Vaart MG, van der Zwet WC, Arends JW, Eeftinck Schattenkerk M, Eddes EH (2006) Rectal carcinoma treated with short-term preoperative radiotherapy followed by abdominoperineal resection. Significantly more presacral abscesses with absence of local recurrence. Dig Surg 23:173–177CrossRefPubMed

20.

Bujko K, Nowacki MP, Kepka L, Oledzki J, Bebenek M, Kryj M, Polish Colorectal Study Group (2005) Postoperative complications in patients irradiated pre-operatively for rectal cancer: report of a randomised trial comparing short-term radiotherapy vs chemoradiation. Colorectal Dis 7:410–416CrossRefPubMed

21.

Valenti V, Hernandez-Lizoain JL, Baixauli J, Pastor C, Aristu J, Diaz-Gonzalez J, Beunza JJ, Alvarez-Cienfuegos JA (2007) Analysis of early postoperative morbidity among patients with rectal cancer treated with and without neoadjuvant chemoradiotherapy. Ann Surg Oncol 14:1744–1751CrossRefPubMed

22.

Birgisson H, Påhlman L, Gunnarsson U, Glimelius B (2007) Late adverse effects of radiation therapy for rectal cancer—a systematic overview. Acta Oncol 46:504–516CrossRefPubMed

23.

Marijnen CA, van de Velde CJ, Putter H, van den Brink M, Maas CP, Martijn Rutten HJ, Wiggers T, Kranenbarg EK, Leer JW, Stiggelbout AM (2005) Impact of short term preoperative radiotherapy on health related quality of live and sexual functioning in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol 23:1847–1858CrossRefPubMed

24.

Peeters KCMJ, Marijnen CAM, Nagtegaal ID, Kranenbarg EK, Putter H, Wiggers T, Rutten H, Pahlmann L, Glimelius B, Leer JW, van de Velde CJH, for the Dutch Colorectal Cancer Group (2007) The TME Trial after a median follow up of 6 years. Increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg 246:693–701CrossRefPubMed

25.

Pollack J, Holm T, Cedermark B, Altman D, Holmström B, Glimelius B, Mellgren A (2006) Late adverse effects of short-course preoperative radiotherapy in rectal cancer. Br J Surg 93:1519–1525CrossRefPubMed

26.

Prabhudesai AG, Cornes P, Glees JP, Kumar D (2005) Long-term morbidity following short-course, pre-operative radiotherapy and total mesorectal excision for rectal cancer. Surgeon 3:347–351PubMedCrossRef

27.

Peeters KCMJ, van de Velde CJH, Leer JWH, Martijn H, Junggeburt JMC, Klein E, Kranenbarg EK, Steup WH, Wiggers T, Rutten HJ, Marijnen CAM (2005) Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: increased bowel dysfunction in irradiated patients—a Dutch Colorectal Cancer Group Study. J Clin Oncol 23:6199–6206CrossRefPubMed

28.

Birgisson H, Påhlman L, Gunnarsson U, Glimelius B (2005) Occurrence of second cancers in patients treated with radiotherapy for rectal cancer. J Clin Oncol 23:6126–6131CrossRefPubMed

29.

Pietrzak L, Bujko K, Nowacki MP, Kepka L, Oledzki J, Rutkowski A, Szmeja J, Kladny J, Dymecki D, Wieczorek A, Pawlak M, Lesniak T, Kowalska T, Richter P, Polish Colorectal Study Group (2007) Quality of life, anorectal and sexual functions after preoperative radiotherapy for rectal cancer: report of a randomised trial. Radiother Oncol 84:217–225CrossRefPubMed

30.

Glimelius B (2006) Rectal cancer irradiation. Long course, short course or something else? Acta Oncol 45:1013–1017CrossRefPubMed

31.

Jacques AE, Rockall AG, Alijani M, Hughes J, Babar S, Aleong JA, Cottrill C, Dorudi S, Reznek RH (2007) MRI demonstration of the effect of neoadjuvant radiotherapy on rectal carcinoma. Acta Oncol 18:1–7

32.

Bakx R, Emous M, Legemate DA, Zoetmulder FA, van Tienhoven G, Bemelman WA, van Lanschot JJ (2006) Harm and benefits of short-term pre-operative radiotherapy in patients with resectable rectal carcinomas. Eur J Surg Oncol 5:520–526CrossRef

33.

Wolberink SV, Beets-Tan RG, Nagtegaal ID, Wiggers T (2006) Preoperative assessment of the circumferential margin in rectal cancer is more informative in treatment planning than the T stage. Tech Coloproctology 10:171–176CrossRef

34.

Nagtegaal ID, Marijnen CAM, Nagtegaal ID, Kranenbarg EK, van de Velde CJH, Krieken HJM (2002) Circumferential margin involvement is still an important predictor of local recurrence in rectal carcinoma: not one millimeter but two millimeters is the limit. Am J Surg Pathol 26:350–357CrossRefPubMed

35.

Branagan G, Chave H, Fuller C, Mc Gee S, Finnes D (2004) Can magnetic resonance imaging predict circumferential margins and TNM stage in rectal cancer. Dis Colon Rectum 8:1317–1322

36.

Peschaud F, Cuenod CA, Benoist S, Julié C, Beauchet A, Siauve N, Taieb-Kasbi F, Penna C, Nordlinger B (2005) Accuracy of magnetic resonance imaging in rectal cancer depends on location of the tumor. Dis Colon Rectum 48:1603–1609CrossRefPubMed

37.

Daniels IR, Fisher SE, Heald RJ, Moran BJ (2007) Accurate staging, selective preoperative therapy and optimal surgery improves outcome in rectal cancer: a review of the recent evidence. Colorectal Dis 9:290–301CrossRefPubMed

38.

Junginger T, Hermanek P, Oberholzer K, Schmidberger H (2006) Rektumkarzinom: Behandeln wir zu häufig neoadjuvant? Vorschläge zu einer selektiveren, MRT-basierten Indikation. [Rectal carcinoma: is too much neoadjuvant therapy performed? Proposals for a more selective MRI based indication]. Zentralbl Chir 131:275–284PubMed

39.

Coucke PA, Notter M, Matter M, Fasolini F, Calmes JM, Schlumpf R, Schwegler N, Stamm B, Phuoc Do H, Bouzourene H (2006) Effect of timing of surgery on survival after preoperative hyperfractionated accelerated radiotherapy (HART) for locally advanced rectal cancer (LARC): is it a matter of days? Acta Oncol 45:1086–1093CrossRefPubMed

40.

Fowler JF (1989) The linear-quadratic formula and progress in fractionated radiotherapy. Br J Radiol 62:679–694CrossRefPubMed

Title: Modified neoadjuvant short-course radiation therapy in uT3 rectal carcinoma: low local recurrence rate with unchanged overall survival and frequent morbidity
Authors: Rainer Kube
Henry Ptok
David Jacob
Jörg Fahlke
Pawel Mroczkowski
Hans Lippert
Gunther Ziegenhardt
Uwe Schmidt
Ingo Gastinger
Publication date: 01-01-2010
Publisher: Springer-Verlag
Published in: International Journal of Colorectal Disease / Issue 1/2010
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-009-0823-y

2024 ASCO Annual Meeting

Springer Medicine

Modified neoadjuvant short-course radiation therapy in uT3 rectal carcinoma: low local recurrence rate with unchanged overall survival and frequent morbidity

Abstract

Purpose

Methods

Results

Conclusions

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2010

Downregulation of IGF-IR expression by RNAi inhibits proliferation and enhances chemosensitization of human colon cancer cells

Perianal Paget’s disease: presentation of six cases and literature review

Analysis of albumin fatty acid binding capacity in patients with benign and malignant colorectal diseases using electron spin resonance (ESR) spectroscopy

Pilot study of bipolar radiofrequency-induced anastomotic thermofusion–exploration of therapy parameters ex vivo

Truncating mutations in Peutz-Jeghers syndrome are associated with more polyps, surgical interventions and cancers

Rectal endosonography: just how good are we at its interpretation?