Download PDF
Clin Colon Rectal Surg 2003; 16(4): 243-248
DOI: 10.1055/s-2004-815615
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Neoadjuvant Radiotherapy for Non-Fixed Rectal Cancer: The Logical Choice

Thomas E. Read
  • Division of Colon and Rectal Surgery, Department of Surgery, Western Pennsylvania Hospital, Clinical Campus of Temple University School of Medicine, Pittsburgh, Pennsylvania
Further Information

Publication History

Publication Date:
12 January 2004 (online)

Also available at
    Permissions and Reprints

ABSTRACT

The inaccuracy of our current pretreatment staging methods, the better efficacy and lower toxicity of neoadjuvant radiotherapy as compared with postoperative radiotherapy, and the additive effect of meticulous surgical technique and radiotherapy make the treatment of patients with non-fixed, uT3N0 rectal adenocarcinoma with neoadjuvant radiotherapy the logical choice. The use of short-course radiotherapy (2000 to 2500 cGy in 5 fractions) may be the best option for the majority of these patients.

KEYWORDS

Rectal cancer - radiotherapy

REFERENCES

  • 1 Read T E, Myerson R J, Fleshman J W. et al . Surgeon specialty is associated with outcome in rectal cancer treatment.  Dis Colon Rectum . 2002;  45 904-914
    CrossrefPubMedGoogle Scholar
  • 2 Holm T, Johansson H, Cedermark B, Ekelund G, Rutqvist L E. Influence of hospital- and surgeon-related factors on outcome after treatment of rectal cancer with or without preoperative radiotherapy.  Br J Surg . 1997;  84 657-663
    CrossrefPubMedGoogle Scholar
  • 3 Porter G A, Soskolne C L, Yakimets W W, Newman S C. Surgeon-related factors and outcome in rectal cancer.  Ann Surg . 1998;  227 157-167
    CrossrefPubMedGoogle Scholar
  • 4 Dahlberg M, Pahlman L, Bergstrom R, Glimelius B. Improved survival in patients with rectal cancer: a population-based register study.  Br J Surg . 1998;  85 515-520
    CrossrefPubMedGoogle Scholar
  • 5 McCall J L. Total mesorectal excision: evaluating the evidence.  Aust N Z J Surg . 1997;  67 599-602
    PubMedGoogle Scholar
  • 6 Luna-Perez P, Reyna Huelga A, Labastida Almendaro S, Rodriguez-Coria D F, Gonzalez Macouzet J, Delgado Gallardo S. The surgeon as prognostic factor for local recurrence and survival in the anal sphincter preservation for mid-rectal cancer.  Rev Invest Clin . 1999;  51 205-213
    PubMedGoogle Scholar
  • 7 Dorrance H R, Docherty G M, O'Dwyer P J. Effect of surgeon specialty interest on patient outcome after potentially curative colorectal cancer surgery.  Dis Colon Rectum . 2000;  43 492-498
    PubMedGoogle Scholar
  • 8 McArdle C S, Hole D. Impact of variability among surgeons on postoperative morbidity and mortality and ultimate survival.  BMJ . 1991;  302 1501-1505
    PubMedGoogle Scholar
  • 9 NIH Consensus Conference. Adjuvant therapy for patients with colon and rectal cancer.  JAMA . 1990;  264 1444-1450
    CrossrefPubMedGoogle Scholar
  • 10 Prolongation of the disease-free survival in surgically treated rectal carcinoma. Gastrointestinal Tumor Study Group.  N Engl J Med . 1985;  312 1565-1573
    PubMedGoogle Scholar
  • 11 Preoperative short-term radiation therapy in operable rectal carcinoma. A prospective randomized trial. Stockholm Rectal Cancer Study Group.  Cancer . 1990;  66 49-55
    CrossrefPubMedGoogle Scholar
  • 12 Randomised trial of surgery alone versus surgery followed by radiotherapy for mobile cancer of the rectum. Medical Research Council Rectal Cancer Working Party.  Lancet . 1996;  348 1610-1614
    CrossrefPubMedGoogle Scholar
  • 13 Randomised trial of surgery alone versus radiotherapy followed by surgery for potentially operable locally advanced rectal cancer. Medical Research Council Rectal Cancer Working Party.  Lancet . 1996;  348 1605-1610
    CrossrefPubMedGoogle Scholar
  • 14 Improved survival with preoperative radiotherapy in resectable rectal cancer. Swedish Rectal Cancer Trial.  N Engl J Med . 1997;  336 980-987
    CrossrefPubMedGoogle Scholar
  • 15 Fleshman J W, Myerson R J. Adjuvant radiation therapy for adenocarcinoma of the rectum.  Surg Clin North Am . 1997;  77 15-25
    CrossrefPubMedGoogle Scholar
  • 16 Marsh P J, James R D, Schofield P F. Adjuvant preoperative radiotherapy for locally advanced rectal carcinoma: results of a prospective, randomized trial.  Dis Colon Rectum . 1994;  37 1205-1214
    PubMedGoogle Scholar
  • 17 Gerard A, Buyse M, Nordlinger B. et al . Preoperative radiotherapy as adjuvant treatment in rectal cancer. Final results of a randomized study of the European Organization for Research and Treatment of Cancer (EORTC).  Ann Surg . 1988;  208 606-614
    PubMedGoogle Scholar
  • 18 Kapiteijn E, Marijnen C A, Nagtegaal I D. et al . Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer.  N Engl J Med . 2001;  345 638-646
    CrossrefPubMedGoogle Scholar
  • 19 Fisher B, Wolmark N, Rockette H. et al . Postoperative adjuvant chemotherapy or radiation therapy for rectal cancer: results from NSABP protocol R-01.  J Natl Cancer Inst . 1988;  80 21-29
    PubMedGoogle Scholar
  • 20 Heald R J, Ryall R D. Recurrence and survival after total mesorectal excision for rectal cancer.  Lancet . 1986;  1 1479-1482
    PubMedGoogle Scholar
  • 21 Heald R J, Moran B J, Ryall R D, Sexton R, MacFarlane J K. Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978-1997.  Arch Surg . 1998;  133 894-899
    CrossrefPubMedGoogle Scholar
  • 22 MacFarlane J K, Ryall R D, Heald R J. Mesorectal excision for rectal cancer.  Lancet . 1993;  341 457-460
    CrossrefPubMedGoogle Scholar
  • 23 Enker W E, Thaler H T, Cranor M L, Polyak T. Total mesorectal excision in the operative treatment of carcinoma of the rectum.  J Am Coll Surg . 1995;  181 335-346
    PubMedGoogle Scholar
  • 24 Arenas R B, Fichera A, Mhoon D, Michelassi F. Total mesenteric excision in the surgical treatment of rectal cancer: a prospective study.  Arch Surg . 1998;  133 608-611
    PubMedGoogle Scholar
  • 25 Wilson S M, Beahrs O H. The curative treatment of carcinoma of the sigmoid, rectosigmoid, and rectum.  Ann Surg . 1976;  183 556-565
    PubMedGoogle Scholar
  • 26 Dukes C. The surgical pathology of rectal cancer.  Proc R Soc Med . 1943;  37 131-144
    PubMedGoogle Scholar
  • 27 Zaheer S, Pemberton J H, Farouk R, Dozois R R, Wolff B G, Ilstrup D. Surgical treatment of adenocarcinoma of the rectum.  Ann Surg . 1998;  227 800-811
    CrossrefPubMedGoogle Scholar
  • 28 Enker W E, Havenga K, Polyak T, Thaler H, Cranor M. Abdominoperineal resection via total mesorectal excision and autonomic nerve preservation for low rectal cancer.  World J Surg . 1997;  21 715-720
    CrossrefPubMedGoogle Scholar
  • 29 Read T E, Ogunbiyi O A, Fleshman J W. et al . Neoadjuvant external beam radiation and proctectomy for adenocarcinoma of the rectum.  Dis Colon Rectum . 2001;  44 1778-1790
    PubMedGoogle Scholar
  • 30 Myerson R, Picus J, Read T. Combining chemotherapy with radiation in the adjuvant care of rectal cancer: morbidity of treatment and its impact on management decisions.  Perspect Colon Rectal Surg . 2000;  12 113-129
    PubMedGoogle Scholar
  • 31 Read T E, McNevin M S, Gross E K. et al . Neoadjuvant therapy for adenocarcinoma of the rectum: tumor response and acute toxicity.  Dis Colon Rectum . 2001;  44 513-522
    PubMedGoogle Scholar
  • 32 Myerson R J, Genovesi D, Lockett M A. et al . Five fractions of preoperative radiotherapy for selected cases of rectal carcinoma: long-term tumor control and tolerance to treatment.  Int J Radiat Oncol Biol Phys . 1999;  43 537-543
    CrossrefPubMedGoogle Scholar
  • 33 Marijnen C A, Kapiteijn E, van de Velde J C. et al . 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 . 2002;  20 817-825
    PubMedGoogle Scholar
  • 34 Valentini V, Coco C, Cellini N. et al . Preoperative chemoradiation for extraperitoneal T3 rectal cancer: acute toxicity, tumor response, and sphincter preservation.  Int J Radiat Oncol Biol Phys . 1998;  40 1067-1075
    CrossrefPubMedGoogle Scholar
  • 35 Marsh R D, Chu N M, Vauthey J N. et al . Preoperative treatment of patients with locally advanced unresectable rectal adenocarcinoma utilizing continuous chronobiologically shaped 5-fluorouracil infusion and radiation therapy.  Cancer . 1996;  78 217-225
    CrossrefPubMedGoogle Scholar
  • 36 Habr-Gama A, de Souza M P, Ribeiro U J. et al . Low rectal cancer: impact of radiation and chemotherapy on surgical treatment.  Dis Colon Rectum . 1998;  41 1087-1096
    PubMedGoogle Scholar
  • 37 Videtic G M, Fisher B J, Perera F E. et al . Preoperative radiation with concurrent 5-fluorouracil continuous infusion for locally advanced unresectable rectal cancer.  Int J Radiat Oncol Biol Phys . 1998;  42 319-324
    CrossrefPubMedGoogle Scholar
  • 38 Minsky B D, Cohen A M, Enker W E. et al . Preoperative 5-FU, low-dose leucovorin, and radiation therapy for locally advanced and unresectable rectal cancer.  Int J Radiat Oncol Biol Phys . 1997;  37 289-295
    CrossrefPubMedGoogle Scholar
  • 39 Hyams D M, Mamounas E P, Petrelli N. et al . A clinical trial to evaluate the worth of preoperative multimodality therapy in patients with operable carcinoma of the rectum: a progress report of National Surgical Adjuvant Breast and Bowel Project Protocol R-03.  Dis Colon Rectum . 1997;  40 131-139
    PubMedGoogle Scholar
  • 40 Janjan N A, Khoo V S, Abbruzzese J. et al . Tumor downstaging and sphincter preservation with preoperative chemoradiation in locally advanced rectal cancer: the M. D. Anderson Cancer Center experience.  Int J Radiat Oncol Biol Phys . 1999;  44 1027-1038
    CrossrefPubMedGoogle Scholar
  • 41 Chan A, Wong A, Langevin J, Khoo R. Preoperative concurrent 5-fluorouracil infusion, mitomycin C and pelvic radiation therapy in tethered and fixed rectal carcinoma.  Int J Radiat Oncol Biol Phys . 1993;  25 791-799
    PubMedGoogle Scholar
  • 42 Janjan N A, Khoo V S, Rich T A. et al . Locally advanced rectal cancer: surgical complications after infusional chemotherapy and radiation therapy.  Radiology . 1998;  206 131-136
    PubMedGoogle Scholar
  • 43 Rich T A, Skibber J M, Ajani J A. et al . Preoperative infusional chemoradiation therapy for stage T3 rectal cancer.  Int J Radiat Oncol Biol Phys . 1995;  32 1025-1029
    CrossrefPubMedGoogle Scholar
  • 44 Dahlberg M, Glimelius B, Graf W, Pahlman L. Preoperative irradiation affects functional results after surgery for rectal cancer: results from a randomized study.  Dis Colon Rectum . 1998;  41 543-551
    CrossrefPubMedGoogle Scholar
  • 45 Birnbaum E H, Dreznik Z, Myerson R J. et al . Early effect of external beam radiation therapy on the anal sphincter: a study using anal manometry and transrectal ultrasound.  Dis Colon Rectum . 1992;  35 757-761
    PubMedGoogle Scholar
  • 46 Birnbaum E H, Myerson R J, Fry R D, Kodner I J, Fleshman J W. Chronic effects of pelvic radiation therapy on anorectal function.  Dis Colon Rectum . 1994;  37 909-915
    PubMedGoogle Scholar
  • 47 Myerson R J, Michalski J M, King M L. et al . Adjuvant radiation therapy for rectal carcinoma: predictors of outcome.  Int J Radiat Oncol Biol Phys . 1995;  32 41-50
    CrossrefPubMedGoogle Scholar
  • 48 Minsky B D, Cohen A M, Kemeny N. et al . The efficacy of preoperative 5-fluorouracil, high-dose leucovorin, and sequential radiation therapy for unresectable rectal cancer.  Cancer . 1993;  71 3486-3492
    PubMedGoogle Scholar
  • 49 Mohiuddin M, Marks G. High-dose preoperative irradiation for cancer of the rectum, 1976-1988.  Int J Radiat Oncol Biol Phys . 1991;  20 37-43
    PubMedGoogle Scholar
  • 50 Kerman H D, Roberson S H, Bloom T S. et al . Rectal carcinoma. Long-term experience with moderately high-dose preoperative radiation and low anterior resection.  Cancer . 1992;  69 2813-2819
    PubMedGoogle Scholar
  • 51 Mendenhall W M, Bland K I, Copeland III M E. et al . Does preoperative radiation therapy enhance the probability of local control and survival in high-risk distal rectal cancer?.  Ann Surg . 1992;  215 696-705
    PubMedGoogle Scholar
  • 52 O'Connell M J, Martenson J A, Wieand H S. et al . Improving adjuvant therapy for rectal cancer by combining protracted-infusion fluorouracil with radiation therapy after curative surgery.  N Engl J Med . 1994;  331 502-507
    CrossrefPubMedGoogle Scholar
  • 53 Tveit K M, Guldvog I, Hagen S. et al . Randomized controlled trial of postoperative radiotherapy and short-term time-scheduled 5-fluorouracil against surgery alone in the treatment of Dukes B and C rectal cancer. Norwegian Adjuvant Rectal Cancer Project Group.  Br J Surg . 1997;  84 1130-1135
    CrossrefPubMedGoogle Scholar
  • 54 Krook J E, Moertel C G, Gunderson L L. et al . Effective surgical adjuvant therapy for high-risk rectal carcinoma.  N Engl J Med . 1991;  324 709-715
    CrossrefPubMedGoogle Scholar
  • 55 Pahlman L, Glimelius B. Pre- or postoperative radiotherapy in rectal and rectosigmoid carcinoma. Report from a randomized multicenter trial.  Ann Surg . 1990;  211 187-195
    CrossrefPubMedGoogle Scholar
  • 56 Minsky B, Cohen A, Enker W. et al . Preoperative 5-fluorouracil, low-dose leucovorin, and concurrent radiation therapy for rectal cancer.  Cancer . 1994;  73 273-280
    PubMedGoogle Scholar
  • 57 Gualdi G F, Casciani E, Guadalaxara A, d'Orta C, Polettini E, Pappalardo G. Local staging of rectal cancer with transrectal ultrasound and endorectal magnetic resonance imaging: comparison with histologic findings.  Dis Colon Rectum . 2000;  43 338-345
    CrossrefPubMedGoogle Scholar
  • 58 Garcia-Aguilar J, Pollack J, Lee S H. et al . Accuracy of endorectal ultrasonography in preoperative staging of rectal tumors.  Dis Colon Rectum . 2002;  45 10-15
    CrossrefPubMedGoogle Scholar
  • 59 Marusch F, Koch A, Schmidt U. et al . Routine use of transrectal ultrasound in rectal carcinoma: results of a prospective multicenter study.  Endoscopy . 2002;  34 385-390
    Article in Thieme ConnectPubMedGoogle Scholar
  • 60 Guillem J G, Puig-La Calle Jr J, Akhurst T. et al . Prospective assessment of primary rectal cancer response to preoperative radiation and chemotherapy using 18-fluorodeoxyglucose positron emission tomography.  Dis Colon Rectum . 2000;  43 18-24
    PubMedGoogle Scholar
  • 61 Sitzler P J, Seow-Choen F, Ho Y H, Leong A P. Lymph node involvement and tumor depth in rectal cancers: an analysis of 805 patients.  Dis Colon Rectum . 1997;  40 1472-1476
    PubMedGoogle Scholar
  • 62 Morson B C. Factors influencing the prognosis of early cancer of the rectum.  Proc R Soc Med . 1966;  59 607-608
    PubMedGoogle Scholar
  • 63 Minsky B D, Rich T, Recht A, Harvey W, Mies C. Selection criteria for local excision with or without adjuvant radiation therapy for rectal cancer.  Cancer . 1989;  63 1421-1429
    PubMedGoogle Scholar
  • 64 Brodsky J T, Richard G K, Cohen A M, Minsky B D. Variables correlated with the risk of lymph node metastasis in early rectal cancer.  Cancer . 1992;  69 322-326
    CrossrefPubMedGoogle Scholar