Multimodal Treatment of Rectal Cancer - Evaluation of Preoperative Radiotherapy

• Authors: Paweł Bury , Krzysztof Zinkiewicz , Aleksander Ciechański , Roman Styliński , Witold Zgodziński , Grzegorz Wallner
• Languages of publication: EN

Abstracts

EN

Colorectal cancer constitutes 10% of all malignant neoplasms and is the fourth most common cancer in men and the third most common cancer in women, worldwide (second most common in Poland). Unfortunately, despite large scale screening programs, changes in diet and lifestyle, colorectal cancer incidence rates for both male and female patients has increased.The aim of the study was to analyze the influence of preoperative radiotherapy (RTH) on the survival and local recurrence rate of patients with rectal cancer, subject to surgical treatment with postoperative (adjuvant) chemotherapy (CTH).Material and methods. The study group comprised 132 patients, including 53 females and 79 males. Patients were divided into the following groups: I - 70 patients treated by means of preoperative radiotherapy, II - 62 patients treated by means of surgery alone. Patients qualified to radiotherapy were diagnosed with stage B (39 patients) and stage C (31 patients) cancer, according to Duke's classification (CT).The patients received 5 Gy each day for a period of 5 days (25 Gy altogether), and underwent surgery. Postoperative pathomorphology demonstrated the following: group I comprised 39 patients with stage B and 31 patients with stage C cancer, whereas group II comprised 34 and 28 patients, respectively. Patients with stage B and C (both groups) received postoperative chemotheraphy - six courses of 5-FU 435 mg/kg/d with leucovorin 20 mg/m2.Results. Kaplan-Meier's survival analysis was applied in each group, according to the following: grade of tumor (pT), lymph node involvement (pN, pN "+",pN "-"), type of surgical resection, stage of cancer, administration of radiotherapy, and presence of local recurrence. Result analysis point to the existing correlation between radiotherapy and the five-year survival rate (p=0.031), and local recurrence (stage B: p=0.1; stage C: p=0.049).Conclusions. Preoperative radiotherapy, considering prospective studies and our own study render hope for better prospects of treating rectal carcinoma in the future, and better 5-year survival rates. Analysis of the five-year survival rates, local recurrences, and distant complications confirmed the effectiveness and safety of preoperative radiotherapy in the treatment of rectal cancer, considering B and C patients.

Keywords

EN

rectal cancer; preoperative radiotherapy; multimodal treatment of rectal cancer

• Publisher: Index Copernicus International
• Journal: Polish Journal of Surgery
• Year: 2010
• Volume: 82
• Issue: 12
• Pages: 657-665

Dates

published

1 - 12 - 2010

online

23 - 2 - 2011

Contributors

author

Paweł Bury

• 2nd Department of General, Gastrointestinal and Surgical Oncology, Alimentary Tract Medical University in Lublin

author

Krzysztof Zinkiewicz

• 2nd Department of General, Gastrointestinal and Surgical Oncology, Alimentary Tract Medical University in Lublin

author

Aleksander Ciechański

• 2nd Department of General, Gastrointestinal and Surgical Oncology, Alimentary Tract Medical University in Lublin

author

Roman Styliński

• 2nd Department of General, Gastrointestinal and Surgical Oncology, Alimentary Tract Medical University in Lublin

author

Witold Zgodziński

• 2nd Department of General, Gastrointestinal and Surgical Oncology, Alimentary Tract Medical University in Lublin

author

Grzegorz Wallner

• 2nd Department of General, Gastrointestinal and Surgical Oncology, Alimentary Tract Medical University in Lublin

References

• Didkowska J, Wojciechowska U, Tarkowski W i wsp.: Nowotwory złośliwe w Polsce w 2002 roku. Krajowy Rejestr Nowotworów 2004.
• Snarska J, Łapucki K, Puchalski Z i wsp.: The role of a therapeutic team and the Pol-Ilko Association in readaptation of patients with stoma to the life in a family and society in the 21st century. Annales Bielostocenis 2005; 50 suppl: 123-25.
• Dziki A, Kołacińska A, Zajdel R et al.: Powikłania stomii jelitowych. Proktologia 2001; 2: 76-86.
• Scripariu V, Dajbog E, Lefter L et al.: Features of pathological assessement in rectal cancer. Rev Med Chir Soc Med Nat Iasir. 2006; 110: 590-97.
• James S Wu: Rectal Cancer Staging. Clin Colon Rectal Surg 2007; 20: 148-57
• Colon and rectum. In: American Joint Committee on Cancer: AJCC Cancer Staging Manual. 6th ed. New York, NY: Springer 2002; 113-24.
• Mocellin S, Lise M, Nitti D: Targeted therapy for colorectal cancer: mapping the way. Trends Mol Med 2005; 11: 327-35.[PubMed][Crossref]
• NCCN Clinical Practice Guidelines in Oncology - Rectal Cancer v.3.2010
• Bujko K, Nowacki M: Operacyjny rak odbytnicy. Napromienianie przed- czy pooperacyjne? Nowotwory 1998; 22: 925-39.
• Knutsen A, Adell G, Sun XF: Inflammatory infiltration, fibrosis, necrosis and mucinous content in relation to clinicopathological and molecular factors in rectal cancers with or without preoperative radiotherapy. Oncol Rep 2006; 16: 321-27.[PubMed]
• Heald RJ, Smedh RK: Abdominoperineal excision of the rectum - an engarded operation. Dis colon Rectum 1997; 40: 747-51.[WoS][PubMed][Crossref]
• Rodel C, Sauer R: Neoadjuvant radiotherapy and radiochemotherapy for rectal cancer. Recent Results Cancer Res 2005; 165: 221-30.
• Dahlberg M, Stenborg A, Pahlman L et al.: Swedish Rectal Cancer Trial. Cost-effectiveness of preoperative radiotherapy in rectal cancer: results from the Swedish Rectal Cancer Trial. Int J Radiat Oncol Biol Phys 2002; 54: 654-60.[Crossref]
• Gunderson LL, Haddock MG, Schild SE: Rectal cancer: Preoperative versus postoperative irradiation as a component of adjuvant treatment. Semin Radiat Oncol 2003; 13: 419-32. Review.[Crossref]
• Glimelius B, Isacsson U: Preoperative radiotherapy for rectal cancer- is 5 × 5 Gy a good or a bad schedule? Acta Oncol 2001; 40: 958-67.
• Maschuw K, Kress R, Ramaswamy A et al.: Short-term preoperative radiotherapy in rectal cancer patients leads to a reduction of the detectable number of lymph nodes in resection specimens. Arch Surg 2006; 39: 364-68.[Crossref]
• Dahl O: The role of radiation therapy for colorectal cancer in light of new trends in surgery and adjuwant chemotherapy. Radiother Oncol 1996; 40 supl 1: S4.[Crossref]
• Glynne-Jones R, Grainger J, Harrison M et al.: Neoadjuvant chemotherapy prior to preoperative chemoradiation or radiation in rectal cancer: should we be more cautious? Br J Cancer 2006; 94: 363-71.[Crossref]
• Dahlberg M, Glimelius B, Pahlman L: Improved survival and reduction in local failure rates after preoperative radiotherapy. Ann Surg 1999; 229: 493-97.
• Bujko K, Nowacki M, Olędzki J et al.: Sphincter preservation after short - term preoperative radiotherapy for low rectal cancer. Acta Oncol 2001; 40: 593-601.
• Arnoletti JP, Bland KI: Neoadjuvant and adjuvant therapy for rectal cancer. Surg Oncol Clin N Am 2006;15: 147-57.[PubMed][Crossref]
• Glimelius B, Gronberg H, Jarhult J et al.: A systematic overeview of radiation therapy effects in rectal cancer. Acta Oncol 2003; 42: 476-92[Crossref]
• Sauer R, Becker H, Hohenberger W et al.: Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004; 351: 1731-40.
• Peeters KC, Kapiteijn E, van de Velde CJ: Managing rectal cancer: the Dutch experience. Colorectal Dis 2003; 5: 423-26.[Crossref]
• Daniels IR, Fisher SE, Heald Rj et al.: Accurate staging, selective preoperative therapy and optimal surgery improves outcome in rectal cancer. A rewiev of the recent evidence. Colorectal Dis 2007; 9: 290-301.[WoS][Crossref]
• Glimelius B, Isacsson U, Jung A et al.: Radiotherapy in addition to radical surgery in rectal cancer: Evidence for a dose-response effectfavouring preoperative treatment. Int I Radiat oncol Biol Phys 1997; 37: 281-87.[Crossref]
• Bujko K, Kolodziejczyk M: The 5 × 5 Gy with delayed surgery in non-resectable rectal cancer: a new treatment option. Radiother Oncol 2008; 87: 311-13.[Crossref]
• Folkesson J, Birgisson H. Pahlman L et al.: Swedish rectal cancer trial.: Long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol 2005; 23: 5644-50.[Crossref]

Identifiers

DOI

10.2478/v10035-010-0101-2