Title: Impact of Neoadjuvant Chemoradiotherapy on Surgical Outcome of Rectal Cancer

Authors: Dr S. Karthikeyan, Dr R. Prabhakaran

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i7.157

Abstract

Background

Multimodality treatment is the most important component of potential for curative resection of Rectal cancer. Local recurrence and metastatic disease in locally advanced Rectal cancer are due to positive circumferential resection margin and lymph node involvement. Overall survival and local recurrence control are improved by Postoperative chemo Radiotherapy, Preoperative Chemo Radiotherapy has increased local control rates, tumor down staging, sphincter saving procedures and enhancing resectability a fact shown by several studies. This study on Neoadjuvant Chemoradiotherapy for carcinoma Rectum evaluates presentation, potential benefits and outcome following multimodality treatment for locally advanced operable Rectal cancer.

References

  1. Boulis Wassif, Gerard MD, J Loygue, Final Results of a Randomized Trial on the Treatment of Rectal Cancer with Preoperative Radiotherapy Alone or in Combination with 5-Fluorouracil, Followed by Radical Surgery, Trial of the European Organization on Research and Treatment of Cancer Gastroinstestinal Tract Cancer Cooperative Group, Cancer 1984; 53:1811-1818.
  2. Heald RJ, Moran BJ, Ryall RD et al. Rectal cancer: The Basingstoke experience of total mesorectal excision, 1978-1997. Arch Surg. 1998; 133; 894-899.
  3. Arbman G, NilssonE, Local recurrence following TME for rectal cancer; BJS 83: 375-79.
  4. Chung-Wah Lam, William Tzu-Liang Chen, Effect of preoperative concurrent chemoradiotherapy in locally advanced low rectal cancer after radical resection surgery. Int Surg 2005:9053-59.
  5. Jin C Kim, Keiichi Takahashi et al, Comparative outcome Between Chemoradiotherapy and Lateral Pelvic Lymph Node Dissection Following Total Mesorectal Excision in Rectal Cancer, Ann Surg 2007 ; 246 ; 754 – 762.
  6. Masato Kusunoki et al, Current Surgical management of Rectal Cancer, Dig Surg 2007 : 24 : 115 – 119.
  7. Steams MW jr, Learning RJ et al Irradiation in inoperable rectal cancer. JAMA 1975 ; 231 : 1388.
  8. Swedish Rectal Cancer Trial Group. Improved survival with preoperative radiotherapy in respectable rectal cancer.NEngl J Med 1997; 336; 980-987.
  9. Frykholm GJ, Pahlman L, Glimelius B. Combined chemo and radiotherapy vs. Radiotherapy alone in the treatment of primary, nonresectable adenocarcinoma of the rectum. Int J Radiat Oncol Biol Phys 2001; 50 : 433-440.
  10. Ruo L, Tikoo S, Klimstra D. Long term prognostic significance of extended rectal cancer response to preoperative radiation and chemotherapy. Am J Surg 2002; 236 : 75-81.
  11. Roh M, Petrelli N, Wieand H. Phase III randomised trial of preoperative versus postoperative multimodality therapy in patients with carcinoma of the rectum (NSABP R-03). J Clin Oncol 2001; 20(suppl 1): 123a
  12. Sauer R, Becker H. Hohenberger W et al. German Rectal Cancer Study Group. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004;351 : 1731 – 1740.
  13. K, Nowacki MP, Nasierowska – Guttmejer A et al. Sphincter preservation following preoperative radiotherapy for rectal cancer: Report of a randomised trial comparing short-term radiotherapy vs. conventionally fractionated radiochemotherapy. Radiother Oncol 2004: 72 : 15-24.
  14. Hyams DM, Mamounas EP, 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 breast and Bowel project protocol R-03. Dis Colon Rectum 1997 : 40 : 131-139.
  15. RobGlynne _ Jones, mark Harrison. Locally Advanced Rectal Cancer : What Is the Evidence for Induction, Oncologist 2007; 12; 1309-1318.
  16. Gerard JP, chapet O, Nemoz C et al. Improved sphincter preservation in low rectal cancer with high-dose preoperative radiotherapy: The Lyon R96-02 randomized trial. J Clin Oncol 2004; 22 : 2404-2409.
  17. Jean-Frangois Bosset, M.D., Laurence Collette, Ph.D., Gilles Calais, M.D., Laurent Mineur, M.D., and Jean-Claude Oilier, M.D., for EORTC Radiotherapy Group Trial 22921 Chemotherapy with Preoperative Radiotherapy in Rectal Cancer N Engl J Med 2006; 355 : 1114-23.
  18. Bosset JF, Calais G, Mineur L et al. Enhanced tumoricidal effect of chemotherapy with preoperative radiotherapy for rectal cancer : Preliminary results – EORTC 22921. J Clin Oncol 2005; 23 : 5620-5627.
  19. Jean-Pierre Gerard, Thierry Controy, Franck bonnetain, Seitz, Bruno Buecher, Remy Mackiewicz, Michel Ducreux, and Laurent Bedenne. Preoperative Radiotherapy with or without Concurrent Fluorouracil and Leucovorin in T3-4 Rectal Cancers : Results of FFCD 9203. J Clin Oncol 24 : 4620-4625.
  20. Rich TA, Skibber JM, Ajani JA, et al. Preoperative infusionl chemoradiation therapy for stage T3 rectal cancer. Int J Radiat Oncol Biol Phys 1995 ; 32 : 1025-9.
  21. Yves Francois et al, Influence of the time interval between preoperative radiation therapy and surgery on downstaging and on the rate of sphincter sparing surgery : The Lyon R 90-01 randomized trial; J of Clinical Oncology, Voll7, No8, 1999, 2396-2402.
  22. Boris Kuvshinoff, Irfan Maghfoor, Brent Miedema, David Ota
  23. Distal Margins requirements after preoperative Chemoradiotherapy for distal rectal carcinomas : Are <=1 cim margin sufficient? : Annals 9of Surgical Oncology : 8 (2) : 163-169.
  24. Jose G. Guillem, David B Chessin, JinruShia, A Prospective pathologic Analysis Using Whole Mount Sections of Rectal Cancer Following Preoperative Combined Modality Therapy, Implications For Shincter Preservation; Ann Surg 2007; 245; 88 – 93.
  25. Kapitjein E, Marijnen CA, Nagtegaal ID et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001; 345; 638-646.
  26. Jose G. Guillem et al. Long-term Oncologic Outcome Following Preoperative Combined Modality Therapy and Total Mesorectal Excision of Locally Advanced Rectal Caner, Ann Surg 2005; 241 : 0829-838).
  27. Karanjia ND, Shache DJ, North WRS Heald RJ. “Close shave” in anterior resection. Br J Surg 1990; 77 : 510-2.
  28. Moore HG, Riedel E, Minsky BD et al. Adequacy of 1 cm distal margin after restorative rectal cancer excision with sharp mesorectal excision and preoperative combined modality therapy. Ann Surg oncology 2003 : 10 : 80-85.
  29. Cam-Ly Tran, SejalUdani, Aliucia Holt, Tracey Amell. Evaluation of safety of increased time interval between chemoradiation and resection for rectal cancer; American Journal of Surgery; 2006; 192; 873-877.
  30. ClaudusRodel, Peter Martus, prognostic significance of Tumour Regression after Chemoradiotherapy for rectal cancer : J of Clinical Oncology, 2005 : 23, 8688 – 8696.
  31. Bujko K, Nowacki MP, Long term results of randomized trial comparing preoperative short course radiotherapy with preoperative conventionally fractionacted chemoradiation for rectal cancer. BJS 2006, Oct : 93 (10) : 1215-23.
  32. Morita T, Murata A, Koyama M :CuiTent status of autonomic nerve preserving surgery for mid and low rectal cancers: Japanese experience with lateral node dissection. Dis of Colon Rectum 2003; 46; S 78-S87.
  33. Medical Research Council Rectal Cancer Working Party. Randomised trial of surgery alone versus radiotherapy followed by surgery for potentially operable locally advanced rectal cancer; Lancet 1996; 348; 1605-1610.
  34. Rullier E, Goffre B, Bonell C. Preoperative radio-chemotherapy and sphincter saving resection in T3 carcionmas of lower third of rectum. Am surg 2001; 234; 633-640.
  35. Ruo L, Tikoo s, klimstra D. Long term prognostic significance of extended rectal cancer response to preoperative radiation and chemotherapy. Am J Surg 2002; 236; 75-81.
  36. Bujko J, kepka L. Michalski et al. Does rectal cancer shrinkage induced by preopertive chemoradiotherapy increase the likelihood of anteror resection? A systematic review of randomized trails. Radiotherapy Oncology 2006; 80; 4-12.
  37. RohMs, colangelo L, Wieand S et al. Response to preoperative multimodality therapy predicts survival in patients wirh carcinoma of rectum.J Clinical oncology 2004; 22; 246s.
  38. Enker WE, Thaler Ht, CranorMl et al. Total Memorectal excision in the operative treatment of carcinoma rectum. J Am coll Surg. 1995; 181; 335-346.
  39. de Haas-Kock DF, Baeten, Jager JJ et al. Prognostic significance of radial margins of clearance in rectal cancer. Br J Surg.1996; 83; 781-785.
  40. Wibe A, Syese A, Andersen E et al. Oncological outcomes after total mesorectal excision for cancer of lower rectum: anterior vs abdominoperineal excision. Dis Colon rectum 2004; 47; 45-58.
  41. Williams NS, Durdley P, Johnston D : The outcome following Sphincter saving resection and abdominoperineal resection of rectum for low rectal cancer; Br J Surg 1985; 72; 595-598.
  42. Law WL, Chu KW. Abdominoperineal excision is assosciatecl with poor Oncological outcome. Br J Surg 2004; 91; 1493-1499.
  43. Tviet KM. guldvog 1, Hagen S, et al. Randomized controlled trial of postoperative radiotherapy and short term time scheduled 5-FU against surgeryalone in treatment of Dukes B and C rectal cancer, Norwegian Adjuvant Rectal Cancer Group. Br J Surg 1997; 84; 1130-1135.
  44. Bouzourence H, Bosnian FT, et al. Importance of tumour regression assessment in predicting outcome in patients with locally advanced rectal carcinoma who are treated with preoperative radiotherapy. Cancer 2002; 94; 1121-1130.
  45. Moore HG, Gittleman AE, Minsky BD, et al: Rate of pathological response with increased time interval between preoperative combined modality therapy and rectal cancer excision. Dis Colon Rectum 2004; 47; 279-286, 46.
  46. Heimann TM, Szporn A, Bolnick K et al. Local recurrence following surgical treatment of rectal cancer. Dis Colon Rectum; 1986; 29; 862-864.
  47. Holm T, Rutquvist LE, Johansspon H et al. Postoperative mortality in rectal cancer treated with and without radiotherapy; causes and risk factors, Br J Surg 1996; 83; 964-968; 48
  48. Bokey EL, Chapuis PH, Dent OF. Factors affecting survival after excision of the rectum for cancer. dis Colon Rectum 1997; 40; 3-40.
  49. Grann A, Minsky BD, Cohen AM, et al. Preliminary results of preoperative 5 fluorouracil, low dose leucovorin and concurrent radiation therapy for respectable T rectal cancer. Dis Colony Rectum 1997; 40; 515-522.
  50. Wichmann MW, Muuller C Meyer G, Strauss T, Homung HM et al. Effect of preoperative chemoradiotherapy on lymphnode retrieval after resection of rectal cancer. Arch Surg 2002; 137; 206-210.
  51. Lavery IC, Lopez-Kostner F, Fazio VW, Fernandez Martin M et al. Chances of cure are not compromised with sphincter saving procedures for cancer of the lower third of rectum. Surgery 2002; 122; 779-785.
  52. Emami B, PilepichM,Willett C et al. Effect of preoperative irradiationonresectability of colorectal carcinomas. Int J Radiat Oncol Biol Phys. 1982; 8: 1295-1299.
  53. Aschele, Carlo, et al., Primary Tumor response to preoperative chemoradiation with our without oxaliplatin in locally advanced rectal cancer: pathologic results of the STAR-01 randomized phase III trial. J Clin Onc. Published online before print. Dio : 10. 1200/JCO.2010.34.4911.
  54. Preoperative chemoradiotherapy and postoperative chemotherapy with fluorouracil and oxaliplatin versus fluorouracil along in locally advaned rectal cancer: initial results of the German CAO/ARO/AIO-04 randomised phase 3 trial – The Lancet Oncology, Volume 13, Issue 7, Pages 679-687, July 2012.
  55. 2010 by American Society of Clinical Oncology Comparison of Two neoad-juvant Chemoradiotherapy Regimens for Locally Advanced Rectal Cancer: Results of the Phase III Trial ACCORD 12/0405-prodige 2.
  56. ARISTOTLE Trial – ARISTOTLE: a phase III trial comparing standard versus novel chemoradiation treatment (CRT) a pre-operative treatment for magnetic resonance imaging (MRI)-defined locally advanced rectal cancer.
  57. Dis Colon Rectum.2013 Jul; 56(7):921-30. timing of surgery after long-course neoadjuvant chemoradiotherapy for rectal cancer: a systematic review of the literature. Foster JD1, Jones EL, Falk S, Cooper EJ, Francis NK.

Corresponding Author

Dr S. Karthikeyan

MMC, Madurai