What Are the Present Recommendations for Short-Course Preoperative Radiotherapy (RT) and Delayed Surgery?
Short-course radiotherapy (RT) to 5 × 5 Gy with immediate surgery is an established treatment to lower local failure rates in many patients with primary rectal cancer. If surgery is delayed for 4–8 weeks, downstaging/downsizing is frequently seen and a pa
- PDF / 200,767 Bytes
- 7 Pages / 504.567 x 720 pts Page_size
- 6 Downloads / 148 Views
Bengt Glimelius
29.1 Introduction
with limited growth toward vagina or uterus only, and probably also node-positive tumors (cN+) Short-course radiotherapy (RT), or 5 fractions of belong to this group as well as some very low 5 Gy, total dose 25 Gy, given during 1 week is an rectal tumors even if less advanced (cT3ab). In established therapy for intermediate-risk (in lit- these intermediate tumors, there is no need for erature most often designated locally advanced) tumor downsizing/downstaging, and surgery rectal cancer since it decreases the risk of local could be done immediately or within a few days. recurrence by at least half [1, 2]. The effects are This is also the way the short-course schedule seen also when appropriate surgery, i.e., total was developed. In more advanced tumors, like mesorectal excision (TME), is done. The higher most cT4b and cT3 tumors growing within a mm the relative efficacy, the better the surgery is from the mesorectal fascia (mrf+), downsizing is (about 70% compared to about 50% in the pre- needed to have a high probability of curative surTME area [1]), but the absolute gain is less and gery or circumferential resection margin negative may not be sufficiently large in many patients to (crm-), and immediate surgery is inappropriate. counterbalance the late negative effects. There is Long-course RT to 46–50 Gy during 4–5 weeks no consensus about what the risk should be after with a delay of 4–6 weeks was used. It was later surgery alone to motivate the use of preoperative replaced by CRT since randomized trials, two in radiotherapy to lower it even further. Most doc- intermediate and one in locally advanced tumors, tors (and likely also patients) consider a risk showed that local control was improved. Survival exceeding 6–8% too high and prescribe RT (or was favorably influenced only in the trial includchemoradiotherapy, CRT) when the anticipated ing locally advanced tumors [3]. risk in patients planned for major surgery is that high or higher. Tumors in this intermediate-risk group are primarily resectable. The more 29.2 Short-Course RT and a Delay advanced clinical stage T3 (cT3cd), cT4a with to Surgery peritoneal involvement anteriorly only, cT4b
29.2.1 Initial and Retrospective Experience B. Glimelius Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala University Hospital, Uppsala, Sweden e-mail: [email protected]
Anecdotal experience early told that tumors found to be irresectable at surgery directly after short-course RT diminished in size and could be
© Springer-Verlag Berlin Heidelberg 2018 V. Valentini et al. (eds.), Multidisciplinary Management of Rectal Cancer, https://doi.org/10.1007/978-3-319-43217-5_29
229
B. Glimelius
230
resected several weeks later. In some patients, no tumor was detectable at surgery, not even histopathologically, i.e., a pathological complete remission (pCR) was achieved. With increasing experience this was used more systematically at some hospitals in very old or frail patients not considered to t
Data Loading...
