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01-01-2016 | Colorectal Cancer

Rectal Cancer: Time for Precision Medicine?

Author: Martin R. Weiser, MD

Published in: Annals of Surgical Oncology | Issue 1/2016

Excerpt

Thirty years ago, the National Surgical Adjuvant Breast and Bowel Project (NSABP) RO1 study was published: a landmark randomized trial demonstrating a rather remarkable reduction in local recurrence from 25 to 16 % when pelvic radiation was added to the treatment regimen of rectal cancer.1 These findings ushered in the modern era of multimodality therapy for rectal cancer including chemotherapy, radiation and surgery. Current local recurrence rates following combined modality therapy for rectal cancer are now routinely reported to be less than 10 %. In spite of the impressive results with multimodality therapy, our colleagues in Heidelberg argue in this issue of Annals of Surgical Oncology that radiation, one of the components of multimodality therapy, can be safely eliminated in a significant proportion of locally advanced (American Joint Committee on Cancer T3/4 or N1/2) rectal cancer patients. Is this sensible? What is the rationale for deviation from chemotherapy, radiation and surgery in the treatment of advanced rectal cancer patients? …

[No authors listed]. NIH consensus conference. Adjuvant therapy for patients with colon and rectal cancer. JAMA. 264:1444–50, 1990

[No authors listed]. Prolongation of the disease-free interval in surgically treated rectal carcinoma. Gastrointestinal tumor study group. N Engl J Med. 312:1465–72, 1985

Fisher B, Wolmark N, Rockette H, Redmond C, Deutsch M, Wickerham DL, Fisher ER, Caplan R, Jones J, Lerner H, et al.: Postoperative adjuvant chemotherapy or radiation therapy for rectal cancer: results from NSABP protocol R-01. J Natl Cancer Inst. 80:21–9, 1988PubMedCrossRef

Krook JE, O’Connell MJ, Wieand HS, Beart RW Jr, Leigh JE, Kugler JW, Foley JF, Pfeifle DM, Twito DI. A prospective, randomized evaluation of intensive-course 5-fluorouracil plus doxorubicin as surgical adjuvant chemotherapy for resected gastric cancer. Cancer 67:2454–8, 1991PubMedCrossRef

Tepper JE, O’Connell MJ, Petroni GR, Hollis D, Cooke E, Benson AB III, Cummings B, Gunderson LL, Macdonald JS, Martenson JA. Adjuvant postoperative fluorouracil-modulated chemotherapy combined with pelvic radiation therapy for rectal cancer: initial results of intergroup 0114. J Clin Oncol. 15:2030–9, 1987

Wolmark N, Rockette H, Fisher B, Wickerham DL, Redmond C, Fisher ER, Jones J, Mamounas EP, Ore L, Petrelli NJ, et al. The benefit of leucovorin-modulated fluorouracil as postoperative adjuvant therapy for primary colon cancer: results from national surgical adjuvant breast and bowel project protocol C-03. J Clin Oncol. 11:1879–87, 1993PubMed

Gunderson LL, Sargent DJ, Tepper JE, O’Connell MJ, Allmer C, Smalley SR, Martenson JA, Haller DG, Mayer RJ, Rich TA, Ajani JA, Macdonald JS, Goldberg RM. Impact of T and N substage on survival and disease relapse in adjuvant rectal cancer: a pooled analysis. Int J Radiat Oncol Biol Phys. 54:386–96, 2002PubMedCrossRef

Tepper JE, O’Connell MJ, Niedzwiecki D, Hollis DR, Benson AB III, Cummings B, Gunderson LL, Macdonald JS, Martenson JA, Mayer RJ. Adjuvant therapy in rectal cancer: analysis of stage, sex, and local control–final report of intergroup 0114. J Clin Oncol. 20:1744–50, 2002PubMedCrossRef

Gunderson LL, Sargent DJ, Tepper JE, Wolmark N, O’Connell MJ, Begovic M, Allmer C, Colangelo L, Smalley SR, Haller DG, Martenson JA, Mayer RJ, Rich TA, Ajani JA, MacDonald JS, Willett CG, Goldberg RM. Impact of T and N stage and treatment on survival and relapse in adjuvant rectal cancer: a pooled analysis. J Clin Oncol. 22:1785–96, 2004PubMedCrossRef

10.

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. German rectal cancer study group: preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 351:1731–40, 2004

11.

Bokey EL, Ojerskog B, Chapuis PH, Dent OF, Newland RC, Sinclair G. Local recurrence after curative excision of the rectum for cancer without adjuvant therapy: role of total anatomical dissection. Br J Surg. 86:1164–70, 1999PubMedCrossRef

12.

Heald RJ, Moran BJ, Ryall RD, Sexton R, MacFarlane JK.: Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978–1997. Arch Surg. 133:894–9, 1998PubMedCrossRef

13.

Merchant NB, Guillem J, Paty PB, Enker WE, Minsky BD, Quan SH, Wong D, Cohen AM.: T3N0 rectal cancer: results following sharp mesorectal excision and no adjuvant therapy. J Gastrointest Surg. 3:642–7, 1999PubMedCrossRef

14.

Folkesson J, Birgisson H, Pahlman L, Cedermark B, Glimelius B, Gunnarsson U.: Swedish rectal cancer trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol. 23:5644–50, 2005PubMedCrossRef

15.

[No authors listed]: Chemotherapy alone or chemotherapy plus radiation therapy in treating patients with locally advanced rectal cancer undergoing surgery. Available at: http://www.cancer.gov/about-cancer/treatment/clinical-trials/search/view?cdrid=715321 Clinical Trials.gov Identifier: NCCTG-N1048

16.

Nagtegaal ID, van de Velde CJ, van der Worp E, Kapiteijn E, Quirke P, van Krieken JH. Cooperative clinical investigators of the Dutch colorectal cancer group: macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol. 20:1729–34, 2002

17.

Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, Rutten HJ, Pahlman L, Glimelius B, van Krieken JH, Leer JW, van de Velde CJ. Dutch colorectal cancer group: preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 345:638–46, 2001

18.

Peeters KC, Marijnen CA, Nagtegaal ID, Kranenbarg EK, Putter H, Wiggers T, Rutten H, Pahlman L, Glimelius B, Leer JW, van de Velde CJ. Dutch colorectal cancer group: 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. 246:693–701, 2007

19.

Aschele C, Pinto C, Cordio S, Rosati G, Tagliagambe A, Artale S, Rosetti P, Lonardi S, Boni L, Cionini L; on behalf of STAR Network Investigators. Properative fluorouracil (FU)-based chemoradiation with and without weekly oxaliplatin in locally advanced rectal cancer: Pathologic response analysis of the Studio Terapia Adiuvante Retto (STAR)-01 randomized phase III trial. J Clin Oncol. 27:CRA4008, 2009

20.

Cercek A Goodman KA, Hajj C, Weisberger E, Segal NH, Reidy-Lagunes DL, Stadler ZK, Wu AJ, Weiser MR, Paty PB, Guillem JG, Nash GM, Temple LK, Garcia-Aguilar J, Saltz LB. Neoadjuvant chemotherapy first, followed by chemoradiation and then surgery, in the management of locally advanced rectal cancer. J Natl Compr Canc Netw. 12:513–9, 2014PubMed

21.

Chau I, Brown G, Cunningham D, Tait D, Wotherspoon A, Norman AR, Tebbutt N, Hill M, Ross PJ, Massey A, Oates J. Neoadjuvant capecitabine and oxaliplatin followed by synchronous chemoradiation and total mesorectal excision in magnetic resonance imaging-defined poor-risk rectal cancer. J Clin Oncol. 24:668–74, 2006PubMedCrossRef

22.

Roh MS, Yothers GA, O’Connell MJ, Beeart RW, Pitot HC, Shields AF, Parda DS, Sharif S, Allegra CJ, Petrelli NJ, Landry JC, Ryan DP, Arora A, Evans TL, Soori GS, Chu L, Landes RV, Mohiuddin M, Lopa S, Wolmark N. The impact of capecitabine and oxaliplatin in the preoperative multimodality treatment in patients with carcinoma of the rectum: NASBP R-04. J Clin Oncol. 29:3503, 2011CrossRef

23.

[No authors listed]. PROSPECT: chemotherapy alone or chemotherapy plus radiation therapy in treating patients with locally advanced rectal cancer undergoing surgery. Available at: https://clinicaltrials.gov/ct2/show/NCT01515787 ClinicalTrials.gov Identifier: NCT01515787

24.

Schrag D, Weiser MR, Goodman KA, Gonen M, Hollywood E, Cercek A, Reidy-Lagunes DL, Gollub MJ, Shia J, Guillem JG, Temple LK, Paty PB, Saltz LB. Neoadjuvant chemotherapy without routine use of radiation therapy for patients with locally advanced rectal cancer: a pilot trial. J Clin Oncol. 32:513–8, 2014PubMedCrossRef

Title: Rectal Cancer: Time for Precision Medicine?
Author: Martin R. Weiser, MD
Publication date: 01-01-2016
Publisher: Springer US
Published in: Annals of Surgical Oncology / Issue 1/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-015-4836-1

At a glance: The STEP trials

Springer Medicine

Rectal Cancer: Time for Precision Medicine?

Excerpt

At a glance: The STEP trials

Springer Medicine

Excerpt

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