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Preoperative radiotherapy in rectal cancers: why a standard in Europe and not in the US?

Nature Clinical Practice Oncology volume 1, pages 56–57 (2004)Cite this article

Although surgery is considered the most important part of treating patients with rectal cancer, the additional use of radiotherapy has changed treatment policy dramatically during the last three decades.

For resectable rectal cancer radiotherapy preoperatively (neoadjuvant) or postoperatively (adjuvant) is optional, used alone or in combination with chemotherapy. Meta-analyses of all randomized trials showed that neoadjuvant treatment is superior to adjuvant treatment for reducing local failure rates and improving cancer-specific survival.1 Only three trials have specifically studied preoperative versus postoperative radiotherapy, and the results from these trials support the findings from the meta-analyses. The Uppsala Trial, the first to report the use of short-course preoperative radiotherapy or postoperative prolonged radiotherapy without chemotherapy in stage II and III advanced rectal cancer, demonstrated that the local recurrence rate (13%) was lower after short-course preoperative radiotherapy compared with selective postoperative radiotherapy (22%). A survival benefit favoring preoperative treatment was observed, but this was not statistically significant.2

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References

  1. Glimelius B et al. (2003) A systematic overview of radiation therapy effects in rectal cancer. Acta Oncol 42. 476–492

    Article  Google Scholar 

  2. Påhlman L and Glimelius B (1990) Pre- or postoperative radiotherapy in rectal and rectosigmoid carcinoma. Report from a randomized multicentre trial. Ann Surg 211: 187–195

    Article  Google Scholar 

  3. Roh MS et al. (2001) Phase III randomized trial of preoperative versus postoperative multimodality therapy in patients with carcinoma of the rectum (NSABP R-03) [abstract]. Proc Am Soc Clin Oncol 20: 123

    Google Scholar 

  4. Sauer R et al. (2003) Adjuvant vs. neoadjuvant radiochemotherapy for locally advanced rectal cancer: the German trial CAO/ARO/AIO-94. Colorectal Dis 5: 406–415

    Article  CAS  Google Scholar 

  5. Beets-Tan RGH et al. (2001) Accuracy of magnetic resonance imaging in prediction of tumour-free resection margins in rectal cancer surgery. Lancet 357: 497–504

    Article  CAS  Google Scholar 

  6. Swedish Rectal Cancer Trial (1997) Improved survival with preoperative radiotherapy in resectable rectal carcinoma. N Engl J Med 336: 980–987

  7. Kapiteijn E et al. (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345: 638–646

    Article  CAS  Google Scholar 

  8. Bosset JF et al. (2000) Preoperative radiochemotherapy versus preoperative radiotherapy with or without postoperative chemotherapy: progress report of the EORTC 22921 trial [abstract]. Radiother Oncol 56: s52

    Google Scholar 

  9. Conroy T et al. (2004) Preoperative (preop) radiotherapy (RT) + 5FU/folinic acid (FA) in T3,4 rectal cancers: preliminary results of the FFCD 9203 randomized trial. [abstract] Proc Am Soc Clin Oncol 23: a3626

    Article  Google Scholar 

  10. Francois Y et al. (1999) Influence of the interval between preoperative radiation therapy and surgery on downstaging and on the rate of sphincter-sparing surgery for rectal cancer: The Lyon R90-01 randomized trial. J Clin Oncol 17: 2396–2402

    Article  CAS  Google Scholar 

  11. Bujko K et al. (2004) Sphincter preservation following preoperative radiotherapy for rectal cancer: report of a randomised trial comparing short-term radiotherapy versus conventionally fractionated radiochemotherapy. Radiother Oncol 72: 15–2475

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Colorectal Unit at the Department of Surgery, University Hospital, Uppsala, Sweden

    Lars Påhlman

  2. Uppsala University,

    Lars Påhlman

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  1. Lars Påhlman
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Correspondence to Lars Påhlman.

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Påhlman, L. Preoperative radiotherapy in rectal cancers: why a standard in Europe and not in the US?. Nat Rev Clin Oncol 1, 56–57 (2004). https://doi.org/10.1038/ncponc0039

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