Preoperative radiotherapy and local excision of rectal cancer with immediate radical re-operation for poor responders.

Autor: Bujko K; Department of Radiotherapy, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, W.K. Roentgena 5, Warsaw, Poland. bujko@coi.waw.pl, Richter P, Kołodziejczyk M, Nowacki MP, Kulig J, Popiela T, Gach T, Oledzki J, Sopyło R, Meissner W, Wierzbicki R, Polkowski W, Kowalska T, Stryczyńska G, Paprota K
Jazyk: angličtina
Zdroj: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology [Radiother Oncol] 2009 Aug; Vol. 92 (2), pp. 195-201. Date of Electronic Publication: 2009 Mar 16.
DOI: 10.1016/j.radonc.2009.02.013
Abstrakt: Background and Purpose: To report an early analysis of prospective study exploring preoperative radiotherapy and local excision in rectal cancer.
Materials and Methods: Mucosa at tumour edges was tattooed. Patients with cT1-3N0 tumour <3-4 cm were treated with either 5x5Gy+4Gy boost (N=31) or chemoradiation (50.4Gy+5.4Gy boost, 1.8Gy per fraction+5-fluorouracyl and leucovorin; N=13). Thirteen patients from the short-course group were unfit for chemotherapy. The interval from radiation to full-thickness local excision was 6 weeks. The protocol called for conversion to a transabdominal surgery in case of ypT2-3 disease or positive margin.
Results: The postoperative complications requiring hospitalization were recorded in 9% of patients. The rate of pathological complete response was 41%. The rate of patients requiring conversion was 34%; however, 18% actually underwent conversion and the remaining 16% refused or were unfit. During the 14 months of median follow-up, local recurrence was detected in 7% of patients and all underwent salvage surgery. Of 19 patients in whom initially anterior resection was likely, 16% had abdominoperineal resection performed for a conversion or as a rescue procedure.
Conclusion: Our study suggests that the short-course radiation prior to local excision is a treatment option for high-risk patients.
Databáze: MEDLINE
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