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By Alessandro Franciscon doctor
Bong Kyung Bae, Min Kyu Kang, Jae-Chul Kim, Mi Young Kim, Gyu-Seog Choi, Jong Gwang Kim, Byung Woog Kang, Hye Jin Kim, Soo Yeun Park
PURPOSE: To evaluate the feasibility of simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) for preoperative concurrent chemoradiotherapy (PCRT) in locally advanced rectal cancer (LARC), by comparing with 3-dimensional conformal radiotherapy (3D-CRT). MATERIALS AND METHODS: Patients who were treated with PCRT for LARC from 2015 January to 2016 December were retrospectively enrolled. Total doses of 45 Gy to 50.4 Gy with 3D-CRT or SIB-IMRT were administered concomitantly with 5-fluorouracil plus leucovorin or capecitabine...
September 2017: Radiation Oncology Journal
Jin Ho Song, Jae Uk Jeong, Jong Hoon Lee, Sung Hwan Kim, Hyeon Min Cho, Jun Won Um, Hong Seok Jang
PURPOSE: Whether preoperative chemoradiotherapy (CRT) is better than postoperative CRT in oncologic outcome and toxicity is contentious in prospective randomized clinical trials. We systematically analyze and compare the treatment result, toxicity, and sphincter preservation rate between preoperative CRT and postoperative CRT in stage II-III rectal cancer. MATERIALS AND METHODS: We searched Medline, Embase, and Cochrane Library from 1990 to 2014 for relevant trials...
September 2017: Radiation Oncology Journal
E Van Cutsem, A Cervantes, R Adam, A Sobrero, J H Van Krieken, D Aderka, E Aranda Aguilar, A Bardelli, A Benson, G Bodoky, F Ciardiello, A D'Hoore, E Diaz-Rubio, J-Y Douillard, M Ducreux, A Falcone, A Grothey, T Gruenberger, K Haustermans, V Heinemann, P Hoff, C-H Köhne, R Labianca, P Laurent-Puig, B Ma, T Maughan, K Muro, N Normanno, P Österlund, W J G Oyen, D Papamichael, G Pentheroudakis, P Pfeiffer, T J Price, C Punt, J Ricke, A Roth, R Salazar, W Scheithauer, H J Schmoll, J Tabernero, J Taïeb, S Tejpar, H Wasan, T Yoshino, A Zaanan, D Arnold
Colorectal cancer (CRC) is one of the most common malignancies in Western countries. Over the last 20 years, and the last decade in particular, the clinical outcome for patients with metastatic CRC (mCRC) has improved greatly due not only to an increase in the number of patients being referred for and undergoing surgical resection of their localised metastatic disease but also to a more strategic approach to the delivery of systemic therapy and an expansion in the use of ablative techniques. This reflects the increase in the number of patients that are being managed within a multidisciplinary team environment and specialist cancer centres, and the emergence over the same time period not only of improved imaging techniques but also prognostic and predictive molecular markers...
August 2016: Annals of Oncology: Official Journal of the European Society for Medical Oncology
Sagar A Patel, Jennifer Y Wo, Theodore S Hong
Since the advent of radiation therapy for rectal cancer, there has been continual investigation of advancing technologies and techniques that allow for improved dose conformality to target structures while limiting irradiation of surrounding normal tissue. For locally advanced disease, intensity modulated and proton beam radiation therapy both provide more highly conformal treatment volumes that reduce dose to organs at risk, though the clinical benefit in terms of toxicity reduction is unclear. For early stage disease, endorectal contact therapy and high-dose rate brachytherapy may be a definitive treatment option for patients who are poor operative candidates or those with low-lying tumors that desire sphincter-preservation...
July 2016: Seminars in Radiation Oncology
Ines Joye, Karin Haustermans
According to current guidelines, the standard treatment for locally advanced rectal cancer patients is preoperative (chemo)radiotherapy followed by total mesorectal excision surgery and adjuvant chemotherapy. Improvements in surgical techniques, imaging modalities, chemotherapy regimens, and radiotherapy delivery have reduced local recurrence rates to less than 10%. The current challenge in rectal cancer treatment lies in the prevention of distant metastases, which still occur in more than 25% of the patients...
July 2016: Seminars in Radiation Oncology
Jennifer Y Wo, Harvey J Mamon, David P Ryan, Theodore S Hong
The optimal oncologic management for patients with T3N0 rectal cancer is currently controversial. Patients with pathologic T3N0 disease may have an "intermediate" risk of disease recurrence, suggesting that perhaps trimodality therapy may not be indicated for all patients. Adverse prognostic features, including a greater depth of perirectal fat invasion, poor tumor differentiation, the presence of lymphovascular invasion, abnormally elevated pretreatment carcinoembryonic antigen levels (>5 ng/mL), circumferential margin involvement, and a low-lying position may identify T3N0 patients at high risk for local recurrence who may benefit from the addition of radiation therapy...
July 2011: Seminars in Radiation Oncology
Joakim Folkesson, Helgi Birgisson, Lars Pahlman, Bjorn Cedermark, Bengt Glimelius, Ulf Gunnarsson
PURPOSE: To evaluate the long-term effects on survival and recurrence rates of preoperative radiotherapy in the treatment of curatively operated rectal cancer patients. PATIENTS AND METHODS: Of 1,168 randomly assigned patients in the Swedish Rectal Cancer Trial between 1987 and 1990, 908 had curative surgery; 454 of these patients had surgery alone, and 454 were administered preoperative radiotherapy (25 Gy in 5 days) followed by surgery within 1 week. Follow-up was performed by matching against three Swedish nationwide registries (the Swedish Cancer Register, the Hospital Discharge Register, and the Cause of Death Register)...
August 20, 2005: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Rolf Sauer, Torsten Liersch, Susanne Merkel, Rainer Fietkau, Werner Hohenberger, Clemens Hess, Heinz Becker, Hans-Rudolf Raab, Marie-Therese Villanueva, Helmut Witzigmann, Christian Wittekind, Tim Beissbarth, Claus Rödel
PURPOSE: Preoperative chemoradiotherapy (CRT) has been established as standard treatment for locally advanced rectal cancer after first results of the CAO/ARO/AIO-94 [Working Group of Surgical Oncology/Working Group of Radiation Oncology/Working Group of Medical Oncology of the Germany Cancer Society] trial, published in 2004, showed an improved local control rate. However, after a median follow-up of 46 months, no survival benefit could be shown. Here, we report long-term results with a median follow-up of 134 months...
June 1, 2012: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Rolf Sauer, Heinz Becker, Werner Hohenberger, Claus Rödel, Christian Wittekind, Rainer Fietkau, Peter Martus, Jörg Tschmelitsch, Eva Hager, Clemens F Hess, Johann-H Karstens, Torsten Liersch, Heinz Schmidberger, Rudolf Raab
BACKGROUND: Postoperative chemoradiotherapy is the recommended standard therapy for patients with locally advanced rectal cancer. In recent years, encouraging results with preoperative radiotherapy have been reported. We compared preoperative chemoradiotherapy with postoperative chemoradiotherapy for locally advanced rectal cancer. METHODS: We randomly assigned patients with clinical stage T3 or T4 or node-positive disease to receive either preoperative or postoperative chemoradiotherapy...
October 21, 2004: New England Journal of Medicine
Andrew G Renehan, Lee Malcomson, Richard Emsley, Simon Gollins, Andrew Maw, Arthur Sun Myint, Paul S Rooney, Shabbir Susnerwala, Anthony Blower, Mark P Saunders, Malcolm S Wilson, Nigel Scott, Sarah T O'Dwyer
BACKGROUND: Induction of a clinical complete response with chemoradiotherapy, followed by observation via a watch-and-wait approach, has emerged as a management option for patients with rectal cancer. We aimed to address the shortage of evidence regarding the safety of the watch-and-wait approach by comparing oncological outcomes between patients managed by watch and wait who achieved a clinical complete response and those who had surgical resection (standard care). METHODS: Oncological Outcomes after Clinical Complete Response in Patients with Rectal Cancer (OnCoRe) was a propensity-score matched cohort analysis study, that included patients of all ages diagnosed with rectal adenocarcinoma without distant metastases who had received preoperative chemoradiotherapy (45 Gy in 25 daily fractions with concurrent fluoropyrimidine-based chemotherapy) at a tertiary cancer centre in Manchester, UK, between Jan 14, 2011, and April 15, 2013...
February 2016: Lancet Oncology
Sarah Roels, Wim Duthoy, Karin Haustermans, Freddy Penninckx, Vincent Vandecaveye, Tom Boterberg, Wilfried De Neve
PURPOSE: Optimization of radiation techniques to maximize local tumor control and to minimize small bowel toxicity in locally advanced rectal cancer requires proper definition and delineation guidelines for the clinical target volume (CTV). The purpose of this investigation was to analyze reported data on the predominant locations and frequency of local recurrences and lymph node involvement in rectal cancer, to propose a definition of the CTV for rectal cancer and guidelines for its delineation...
July 15, 2006: International Journal of Radiation Oncology, Biology, Physics
N Taylor, C Crane, J Skibber, B Feig, L Ellis, J N Vauthey, S Hamilton, K Cleary, R Dubrow, T Brown, R Wolff, P Hoff, N Sanfilippo, N Janjan
PURPOSE: To evaluate the inguinal nodal failure rate in patients with locally advanced rectal cancer with anal canal involvement (ACI) treated with pelvic chemoradiation without elective inguinal irradiation. METHODS AND MATERIALS: From 1990 and 1998, 536 patients received preoperative or postoperative chemoradiation for rectal cancer with curative intent; 186 patients had ACI (<4 cm from the anal verge on rigid proctoscopy). Two patients had positive inguinal nodes at presentation...
November 1, 2001: International Journal of Radiation Oncology, Biology, Physics
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