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Neoadjuvant chemoradiation versus hyperfractionated accelerated radiotherapy in locally advanced rectal cancer

Wim Ceelen UGent, Tom Boterberg UGent, Piet Pattyn UGent, Marc Van Eijkeren UGent, Jean-Pierre Gillardin UGent, Pieter Demetter, PETER SMEETS UGent, Nancy Van Damme UGent, ELS MONSAERT and Marc Peeters UGent (2007) ANNALS OF SURGICAL ONCOLOGY. 14(2). p.424-431
abstract
Background: Neoadjuvant therapy is increasingly used in resectable locally advanced rectal cancer. The exact role of the addition of chemotherapy is not established. We compared neoadjuvant therapy using chemoradiation (CRT) or hyperfractionated accelerated radiotherapy (HART). Methods: Clinical, pathological, and survival data were obtained from patients with resectable stage II or III rectal cancer within 7 cm from the anal verge. A group of 50 patients was treated with a preoperative dose of 41.6 Gy of radiotherapy (RT) in two daily fractions of 1.6 Gy over 13 days immediately followed by surgery (HART). A second group of 96 patients received 45 Gy of conventionally fractionated RT in 25 daily fractions of 1.8 Gy combined with 5-fluorouracil-based chemotherapy followed by surgery within 4 to 6 weeks (CRT). Both groups were compared in terms of morbidity, pathological downstaging, local recurrence, and survival. Results: Both groups were comparable in terms of preoperative clinicopathological variables. The mean distance from the anal verge was 5.8 cm (HART) versus 4.9 cm (CRT). Sphincter preservation was possible in 74% (HART) versus 83.5% (CRT) of patients (P = .013). The clinical anastomotic leak rate was 2% (HART) versus 2.2% (CRT). Pathological complete response was observed in 4% (HART) versus 18% (CRT) of the resected specimens (P = .002). A pelvic recurrence developed in 6% (HART) versus 4.4% (CRT) of patients (P = .98). Overall 5-year survival was 58% (HART) versus 66% (CRT) (P = .19); disease-free 5-year survival was 51% (HART) versus 62% (CRT) (P = .037). Conclusions: Compared with preoperative HART followed by immediate surgery, preoperative CRT followed by a 6-week waiting period enhances pathological response and increases sphincter preservation rate. This could be explained by the addition of chemotherapy or the longer interval between neoadjuvant therapy and surgery. No statistically significant difference was observed in local control or overall survival.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
PREOPERATIVE RADIATION-THERAPY, rectal cancer, LOW ANTERIOR RESECTION, RANDOMIZED-TRIAL, SPHINCTER PRESERVATION, PHASE-II, ACID FA, CARCINOMA, RADIOCHEMOTHERAPY, SURGERY, TOTAL MESORECTAL EXCISION, chemoradiation, hyperfractionated accelerated therapy, total mesorectal excision, neoadjuvant
journal title
ANNALS OF SURGICAL ONCOLOGY
Ann. Surg. Oncol.
volume
14
issue
2
pages
424 - 431
Web of Science type
Article
Web of Science id
000243765500022
JCR category
SURGERY
JCR impact factor
3.917 (2007)
JCR rank
6/139 (2007)
JCR quartile
1 (2007)
ISSN
1068-9265
DOI
10.1245/s10434-006-9102-0
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
413593
handle
http://hdl.handle.net/1854/LU-413593
date created
2007-03-01 17:45:00
date last changed
2010-08-17 13:30:35
@article{413593,
  abstract     = {Background: Neoadjuvant therapy is increasingly used in resectable locally advanced rectal cancer. The exact role of the addition of chemotherapy is not established. We compared neoadjuvant therapy using chemoradiation (CRT) or hyperfractionated accelerated radiotherapy (HART).
Methods: Clinical, pathological, and survival data were obtained from patients with resectable stage II or III rectal cancer within 7 cm from the anal verge. A group of 50 patients was treated with a preoperative dose of 41.6 Gy of radiotherapy (RT) in two daily fractions of 1.6 Gy over 13 days immediately followed by surgery (HART). A second group of 96 patients received 45 Gy of conventionally fractionated RT in 25 daily fractions of 1.8 Gy combined with 5-fluorouracil-based chemotherapy followed by surgery within 4 to 6 weeks (CRT). Both groups were compared in terms of morbidity, pathological downstaging, local recurrence, and survival.
Results: Both groups were comparable in terms of preoperative clinicopathological variables. The mean distance from the anal verge was 5.8 cm (HART) versus 4.9 cm (CRT). Sphincter preservation was possible in 74\% (HART) versus 83.5\% (CRT) of patients (P = .013). The clinical anastomotic leak rate was 2\% (HART) versus 2.2\% (CRT). Pathological complete response was observed in 4\% (HART) versus 18\% (CRT) of the resected specimens (P = .002). A pelvic recurrence developed in 6\% (HART) versus 4.4\% (CRT) of patients (P = .98). Overall 5-year survival was 58\% (HART) versus 66\% (CRT) (P = .19); disease-free 5-year survival was 51\% (HART) versus 62\% (CRT) (P = .037).
Conclusions: Compared with preoperative HART followed by immediate surgery, preoperative CRT followed by a 6-week waiting period enhances pathological response and increases sphincter preservation rate. This could be explained by the addition of chemotherapy or the longer interval between neoadjuvant therapy and surgery. No statistically significant difference was observed in local control or overall survival.},
  author       = {Ceelen, Wim and Boterberg, Tom and Pattyn, Piet and Van Eijkeren, Marc and Gillardin, Jean-Pierre and Demetter, Pieter and SMEETS, PETER and Van Damme, Nancy and MONSAERT, ELS and Peeters, Marc},
  issn         = {1068-9265},
  journal      = {ANNALS OF SURGICAL ONCOLOGY},
  keyword      = {PREOPERATIVE RADIATION-THERAPY,rectal cancer,LOW ANTERIOR RESECTION,RANDOMIZED-TRIAL,SPHINCTER PRESERVATION,PHASE-II,ACID FA,CARCINOMA,RADIOCHEMOTHERAPY,SURGERY,TOTAL MESORECTAL EXCISION,chemoradiation,hyperfractionated accelerated therapy,total mesorectal excision,neoadjuvant},
  language     = {eng},
  number       = {2},
  pages        = {424--431},
  title        = {Neoadjuvant chemoradiation versus hyperfractionated accelerated radiotherapy in locally advanced rectal cancer},
  url          = {http://dx.doi.org/10.1245/s10434-006-9102-0},
  volume       = {14},
  year         = {2007},
}

Chicago
Ceelen, Wim, Tom Boterberg, Piet Pattyn, Marc Van Eijkeren, Jean-Pierre Gillardin, Pieter Demetter, Peter Smeets, Nancy Van Damme, ELS MONSAERT, and Marc Peeters. 2007. “Neoadjuvant Chemoradiation Versus Hyperfractionated Accelerated Radiotherapy in Locally Advanced Rectal Cancer.” Annals of Surgical Oncology 14 (2): 424–431.
APA
Ceelen, Wim, Boterberg, T., Pattyn, P., Van Eijkeren, M., Gillardin, J.-P., Demetter, P., Smeets, P., et al. (2007). Neoadjuvant chemoradiation versus hyperfractionated accelerated radiotherapy in locally advanced rectal cancer. ANNALS OF SURGICAL ONCOLOGY, 14(2), 424–431.
Vancouver
1.
Ceelen W, Boterberg T, Pattyn P, Van Eijkeren M, Gillardin J-P, Demetter P, et al. Neoadjuvant chemoradiation versus hyperfractionated accelerated radiotherapy in locally advanced rectal cancer. ANNALS OF SURGICAL ONCOLOGY. 2007;14(2):424–31.
MLA
Ceelen, Wim, Tom Boterberg, Piet Pattyn, et al. “Neoadjuvant Chemoradiation Versus Hyperfractionated Accelerated Radiotherapy in Locally Advanced Rectal Cancer.” ANNALS OF SURGICAL ONCOLOGY 14.2 (2007): 424–431. Print.