open access

Vol 20, No 1 (2015)
Reviews
Published online: 2015-01-01
Submitted: 2013-08-29
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Could preoperative short-course radiotherapy be the treatment of choice for localized advanced rectal carcinoma?

Juan Pablo Ciria, Mikel Eguiguren, Sergio Cafiero, Intza Uranga, Ivan Diaz de Cerio, Arrate Querejeta, Jose Maria Urraca, Julian Minguez, Elena Guimon, Jose Ramón Puertolas
DOI: 10.1016/j.rpor.2014.06.003
·
Rep Pract Oncol Radiother 2015;20(1):1-11.

open access

Vol 20, No 1 (2015)
Reviews
Published online: 2015-01-01
Submitted: 2013-08-29

Abstract

Short-course preoperative radiotherapy (RT) is widely used in northern Europe for locally advanced resectable rectal cancer, but its role in the era of advanced imaging techniques is uncertain. Here, we reviewed articles and abstracts on SCRT published from 1974 through 2013 with the goal of identifying patients who might be best suited for short-course RT. We included relevant articles comparing surgery with or without preoperative radiation published before and after the advent of total mesorectal excision. We also analyzed two randomized trials directly comparing short-course RT with conventionally fractionated chemoradiation (the Polish Colorectal Study Group and the Trans-Tasman Radiation Oncology Group) that compared short-course RT with conventional chemoradiotherapy. We conclude from our review that short-course RT can be generally applied for operable rectal cancer and produces high rates of pelvic control with acceptable toxicity; it reduces local recurrence rates but does not increase overall survival. SCRT seems to be best used for tumors considered “low risk,” i.e., those that are >5[[ce:hsp sp="0.25"/]]cm from the anal margin, without circumferential margin involvement, and involvement of fewer than 4 lymph nodes. Whether sequential chemotherapy can further improve outcomes remains to be seen, as does the best time for surgery (immediately or 6–8 weeks after RT). We further recommend that selection of patients for short-course RT should be based on findings from magnetic resonance imaging or transrectal ultrasonography.

Abstract

Short-course preoperative radiotherapy (RT) is widely used in northern Europe for locally advanced resectable rectal cancer, but its role in the era of advanced imaging techniques is uncertain. Here, we reviewed articles and abstracts on SCRT published from 1974 through 2013 with the goal of identifying patients who might be best suited for short-course RT. We included relevant articles comparing surgery with or without preoperative radiation published before and after the advent of total mesorectal excision. We also analyzed two randomized trials directly comparing short-course RT with conventionally fractionated chemoradiation (the Polish Colorectal Study Group and the Trans-Tasman Radiation Oncology Group) that compared short-course RT with conventional chemoradiotherapy. We conclude from our review that short-course RT can be generally applied for operable rectal cancer and produces high rates of pelvic control with acceptable toxicity; it reduces local recurrence rates but does not increase overall survival. SCRT seems to be best used for tumors considered “low risk,” i.e., those that are >5[[ce:hsp sp="0.25"/]]cm from the anal margin, without circumferential margin involvement, and involvement of fewer than 4 lymph nodes. Whether sequential chemotherapy can further improve outcomes remains to be seen, as does the best time for surgery (immediately or 6–8 weeks after RT). We further recommend that selection of patients for short-course RT should be based on findings from magnetic resonance imaging or transrectal ultrasonography.

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Keywords

Locally advanced rectal cancer; Short course preoperative radiotherapy; Neoadjuvant radiation therapy; Prognostic factors

About this article
Title

Could preoperative short-course radiotherapy be the treatment of choice for localized advanced rectal carcinoma?

Journal

Reports of Practical Oncology and Radiotherapy

Issue

Vol 20, No 1 (2015)

Pages

1-11

Published online

2015-01-01

DOI

10.1016/j.rpor.2014.06.003

Bibliographic record

Rep Pract Oncol Radiother 2015;20(1):1-11.

Keywords

Locally advanced rectal cancer
Short course preoperative radiotherapy
Neoadjuvant radiation therapy
Prognostic factors

Authors

Juan Pablo Ciria
Mikel Eguiguren
Sergio Cafiero
Intza Uranga
Ivan Diaz de Cerio
Arrate Querejeta
Jose Maria Urraca
Julian Minguez
Elena Guimon
Jose Ramón Puertolas

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