Long-course Radiochemotherapy Research Articles

Preoperative radiotherapy for rectal cancer: A bibliometric analysis of the 100 most-cited research articles.

Preoperative long-course radio-chemotherapy (LC-RCHT) or preoperative short-course radiotherapy (SC-RT) are widely used in the treatment of locally advanced rectal cancer (LARC). This study aimed to evaluate the 100 most-cited research articles focused on preoperative radiotherapy for rectal cancer to reveal existing academic trends and the direction of therapeutic research. This was a retrospective study based on publicly accessible data. The Web of Science database was used to identify the 100 most-cited articles. The median values for total citation and average citation per year (CPY) were 240.50 (range, 150-3787) and 17.32 (5.03-222.76), respectively. Randomized (median: 24.88 vs 13.32, P = 0.001) and funded (median: 27.33 vs 14.73, P = 0.002) studies had more CPY than those with opposite characteristics. No significant difference was found between studies using SC-RT and LC-RCHT, in terms of average CPY (median: 15.27 for SC-RT vs 18.36 for LC-RCHT, P = 0.303). In terms of the primary aim of the investigation, studies investigating non-operative treatment strategies had higher CPY than those investigating other subcategories (p = 0.029). Randomized studies, funded studies, and studies investigating non-operative treatment were associated with more CPY. There remains equal interest in preoperative SC-RT and LC-RCHT for rectal cancer.

Transanal endoscopic microsurgery vs total mesorectal excision in YPT0-1 rectal cancer after pre-operative radiochemotherapy: Post-operative morbidity, long-term oncologic outcome and functional results

Aims of the study were to retrospectively evaluate the short-term post-operative (p.o.) morbidity, the oncologic long-term outcome and the functional outcome at 1 year from surgery in patients treated by Transanal Endoscopic Microsurgery (TEM) or by Total Mesorectal Excision (TME) after pre-operative long-course radiochemotherapy (RCT) for locally advanced extraperitoneal rectal cancer which obtain a complete or major pathological response (ypT0-1) after neoadjuvant treatment.

540P - A phase Ib study of E7046 (AN0025) in combination with radiotherapy/chemoradiotherapy (RT/CRT) in preoperative treatment of rectal cancer

BackgroundAN0025 (previously E7046) is a selective inhibitor of the EP4 receptor and targets macrophages and immunosuppressive cells of myeloid lineage in tumor microenvironment. Preclinical studies have shown potent antitumor activity with AN0025 combining with RT and animal model data suggested antitumor memory T-cell response development by the combination. Neoadjuvant treatment of high-risk rectal cancer provides the platform to test such novel agents to clarify safety and efficacy and provide biopsy and surgical specimens for biomarker analysis. MethodsThis is a multicenter, open-label, Phase 1b study in patients (pts) with poor prognosis locally advanced rectal cancer as defined by standard MRI. This ongoing study enrolled pts into two groups, AN0025 in combination with Long Course Radio Chemotherapy (LCRT), or Short Course Radiotherapy (SCRT) followed by chemotherapy. The dose escalation design comprised 2 dose levels, 250mg and 500mg QD for both SCRT and LCRT. Treatment duration was 10 weeks followed by surgery at week 14-16. Pre-surgery MRI was done at week 11-13. Primary objective was safety and tolerability of AN0025 + CRT. ResultsAs of 23 Apr 2019, 27 pts were enrolled. 14 pts were treated in 250mg cohort with 7 pts in LCRT and in SCRT. No DLT was observed among 13 evaluable pts in this dose level. 500mg cohort is ongoing, 13 pts enrolled. Overall, 18 (66.7%) pts had treatment-related AEs (TRAE), most commonly fatigue (25.9%), diarrhea (14.8%), nausea (11.1%), decreased appetite (11.1%), headache (11.1%), and paraesthesia (11.1%). 2 pts experienced grade 3 TRAEs (diarrhea and fatigue) and 1pt had serious TRAEs (abdominal pain, vomiting, and fatigue). Median age was 59, 74% were male, 41% had ECOG 1, 56% with T stage T3c-T4b, and 63% were EMVI+. For 250mg cohort, pre-surgery MRI showed 6/13 pts had downstaging in T stage (3 each in LCRT and SCRT) and mrTRG 1-2 rate was 46% (43% and 50% in LCRT and SCRT respectively). Clinical responses led to 5/13 pts (38%) managed by a watch-and-wait approach. ConclusionsAN0025 was well tolerated in combination with chemoradiation and preliminary efficacy results are encouraging. Additional safety and efficacy data will be presented. Clinical trial identificationNCT03152370. Legal entity responsible for the studyAdlai Nortye USA. FundingAdlai Nortye USA. DisclosureL. Wyrwicz: Honoraria (self), Honoraria (institution): EISAI; Honoraria (self): Adlai Nortye USA. M.P. Saunders: Honoraria (self): Servier, Merck, Amgen, Sanofi. M. Hall: Advisory / Consultancy, Travel / Accommodation / Expenses: Roche, Tesaro, Clovis Oncology; Advisory / Consultancy: AstraZeneca, Amgen. V. Bhagawati Prasad: Full / Part-time employment: Eisai. N. Lautermilch: Full / Part-time employment: Adlai Nortye. M.M. Rashford: Full / Part-time employment: Adlai Nortye. J. Jin: Full / Part-time employment: Adlai Nortye. S. Formenti: Research grant / Funding (self): Bristol-Myers Squibb, Varian, Janssen, Regeneron, Eisai, Merck, Celldex; Honoraria (self): Bristol-Myers Squibb, Varian, Elekta, Janssen, Regeneron, GlaxoSmithKline, Eisai, AstraZeneca, Merck, Viewray, Bayer. R. Glynne-Jones: Advisory / Consultancy: Eisai, Sanofi, Servier, Amgen. All other authors have declared no conflicts of interest.

Surgical complications after different therapeutic approaches for locally advanced rectal cancer.

BACKGROUNDPreoperative radiochemotherapy is widely used in locally advanced rectal cancer. It can improve local control of rectal cancer. However, some researchers believe it increases the incidence of surgical complications. They doubt its safety. Patients with locally advanced rectal cancer receive three different treatments in our hospital, including long-course radiochemotherapy, short-course radiotherapy, and surgery directly. We can compare their differences in postoperative complications.AIMTo investigate surgical complications caused by different preoperative radiotherapy regimens.METHODSWe retrospectively analyzed 1197 patients admitted between 2008 and 2010 with locally advanced rectal cancer. Three hundred and forty-six patients were treated with preoperative long-course radiochemotherapy (25 × 2 Gy) followed by total mesorectal excision (TME) 6–8 wk later, and 259 patients received short-course radiotherapy (10 × 3 Gy) and subsequently TME 7–10 d later. The remaining 592 patients underwent TME alone without neoadjuvant therapy. According to Clavien–Dindo classification, surgical complications were evaluated for up to 30 d after discharge from hospital.RESULTSThere were no deaths in 30 d in all groups after treatment. The major complications were anastomotic leakage and perineal wound complications. The results suggested that both long-course [odds ratio (OR) = 3.624, 95% confidence interval (CI): 1.689–7.775, P = 0.001] and short-course (OR = 5.150, 95%CI: 1.828–14.515, P = 0.002) radiotherapy were associated with anastomotic leakage. Temporary ileostomy was a protective factor for anastomotic leakage (OR = 6.211, 95%CI: 2.525–15.385, P < 0.001). The severity of anastomotic leakage did not increase in patients following preoperative radiotherapy (P = 0.411). Compared with TME alone, short-course radiotherapy was associated with an increase in perineal wound complications (OR = 5.565, 95%CI: 2.203–14.057, P < 0.001), but long-course radiotherapy seemed safe regarding this complication (OR = 1.692, 95%CI: 0.651–4.394, P = 0.280). Although the severity of perineal wound complications increased in patients following short-course radiotherapy (P < 0.001), additional intervention was not necessary.CONCLUSIONRadiotherapy increased the incidence but not severity of anastomotic leakage. Short-course radiotherapy was also accompanied with perineal wound complications, but intervention appeared unnecessary to ameliorate the complications.

The INTERACT Trial: Long-term results of a randomised trial on preoperative capecitabine-based radiochemotherapy intensified by concomitant boost or oxaliplatin, for cT2 (distal)–cT3 rectal cancer

Background and purposeCapecitabine-based radiochemotherapy (cbRCT) is standard for preoperative long-course radiochemotherapy of locally advanced rectal cancer. This prospective, parallel-group, randomised controlled trial investigated two intensification regimens. cT4 lesions were excluded. Primary objective: pathological outcome (TRG 1-2) among arms. Materials and methodsLow-located cT2N0–2M0, cT3N0–2M0 (up to 12 cm from anal verge) presentations were treated with cbRCT randomly intensified by either radiotherapy boost (Xelac arm) or multidrug concomitant chemotherapy (Xelox arm). Xelac: concomitant boost to bulky site (45 Gy/1.8 Gy/die, 5 sessions/week to the pelvis, +10 Gy at 1 Gy twice/week to the bulky) plus concurrent capecitabine (1650 mg/mq/die). Xelox: 45 Gy to the pelvis + 5.4 Gy/1.8 Gy/die, 5 sessions/week to the bulky site + concurrent capecitabine (1300 mg/mq/die) and oxaliplatin (130 mg/mq on days 1,19,38). Surgery was planned 7–9 weeks after radiochemotherapy. ResultsFrom June 2005 to September 2013, 534 patients were analysed: 280 in Xelac, 254 in Xelox arm. Xelox arm presented higher G ≥ 3 haematologic (p = 0.01) and neurologic toxicity (p < 0.001). Overall, 98.5% patients received curative surgery. The tumour regression grade distribution did not differ between arms (p = 0.102). TRG 1+2 rate significantly differed: Xelac arm 61.7% vs. Xelox 52.3% (p = 0.039). Pathological complete response (ypT0N0) rates were 24.4 and 23.8%, respectively (p non-significant). Median follow-up:5.62 years. Five-year disease-free survival rate were 74.7% (Xelac) and 73.8% (Xelox), respectively (p = 0.444). Five-year overall survival rate were 80.4% (Xelac) and 85.5% (Xelox), respectively (p = 0.155). ConclusionXelac arm significantly obtained higher TRG1-2 rates. No differences were found about clinical outcome. Because of efficacy on TRG, inferior toxicity and good compliance, Xelac schedules or similar radiotherapy dose intensification schemes could be considered as reference treatments for cT3 lesions.

Preoperative short-course radiotherapy and long-course radiochemotherapy for locally advanced rectal cancer: Meta-analysis with trial sequential analysis of long-term survival data.

Background and purposeThe role of preoperative short-course radiotherapy (SCRT) in rectal cancer treatment, when compared to long-course radiochemotherapy (LCRT), is still controversial. Thus the meta-analysis with trial sequential analysis (TSA) was performed to evaluate the long-term survival of SCRT and LCRT as therapeutic regimens for locally advanced rectal cancer.Material and methodsPubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched up to August 2017 for eligible studies. Hazard ratios (HRs) or odds ratios (ORs) of overall survival (OS), disease free survival (DFS) and local recurrence (LR) with the corresponding 95% confidence intervals (CIs) were calculated and TSA was applied.Results11 studies with 1984 patients were included. There was no significant difference in OS (HR = 0.92, 95% CI: 0.75–1.13, p = 0.44), DFS (HR = 0.94, 95% CI: 0.79–1.12, p = 0.50) and LR (OR = 0.73, 95% CI: 0.49–1.08, p = 0.11) between SCRT and LCRT groups. TSA suggested firm evidence for lacking on average a -10% relative risk reduction (RRR) in 4-year OS but no statistical significance in 4-year DFS.ConclusionsPreoperative SCRT is as effective as LCRT for locally advanced colorectal cancer in long-term survival. SCRT could be preferential while facing long waiting lists or lacking medical resource.

EP-1284: Impact of surgical delay after long-course radiochemotherapy in rectal cancer

EP-1284: Impact of surgical delay after long-course radiochemotherapy in rectal cancer

Observation on the effect of preoperative radiotherapy on the local advanced middle and low rectal cancer

Objective To discuss the treatment efficacy and radiotherapy side effects of the preoperative long-course radiochemotherapy and preoperative short-course radiotherapy. Methods 64 patients with local advanced middle and low rectal cancer who got the treatment from April 2004 to April 2010 were analyzed retrospectively. 40 patients got the preoperative long-course radiochemotherapy under the dose of DT 45-50 Gy/25 F, 1.8-2.0 Gy/F, 5 F/W, combining with the synchronous capecitabine chemotherapy (1 650 mg/m2, 2 F/d, d1-14/d21-35), and accepted operation 4-6 weeks after the radiotherapy. The rest 24 patients underwent the preoperative short-course radiotherapy under the dose of DT 25 Gy/5 F, 5 Gy/F, 5 F/W, and got the operation in 2 weeks after the radiotherapy. Results The radical and anus reservation rates in preoperative long-course radiochemotherapy group [85.0 % (34/40), 65.0 % (26/40)] were higher than those in preoperative short-course radiotherapy group [58.3 % (14/24), 33.3 % (8/24)] (χ2 = 5.689, P= 0.019; χ2 = 6.040, P= 0.041). There were no significant differences between the two groups on the index of remission rates, radiation injury, surgical complications, and overall survival rate of 1, 3, 5 years (all P> 0.05). Conclusions The remission rate and overall survival time between the preoperative long-course radiochemotherapy group and preoperative short-course radiotherapy have no significant difference. But the preoperative long-course radiochemotherapy may improve the anus reservation rate and the radical resection rate, without increasing the radiation injury and surgical complications. Key words: Rectal neoplasms; Radiotherapy; Colorectal surgery

Long-term quality-of-life after neoadjuvant short-course radiotherapy and long-course radiochemotherapy for locally advanced rectal cancer

PurposeTo evaluate long-term quality-of-life (QoL) after neoadjuvant short-course radiotherapy (SC-RT) and long-course radiochemotherapy (LC-RCHT) for locally advanced rectal cancer. MethodsBetween 1999 and 2008, 225 patients were treated with curative intent for locally advanced rectal cancer using neoadjuvant SC-RT (n=108) or LC-RCHT (n=117). SC-RT delivered 10×2.9Gy twice daily with immediate surgery. LC-RCHT delivered 28×1.8Gy concomitant with 5-FU based chemotherapy and delayed surgery. A cross-sectional QoL analysis was performed in disease-free patients using the EORTC-QLQ-C30 and EORTC-QLQ-CR29 questionnaires. ResultsAfter a median follow-up of 67months, 133 patients were disease-free of which 120 (90%) returned the QoL questionnaires. Patients in the LC-RCHT cohort had a higher rate of uT4, uN+ and low tumor location. No difference in QoL was observed between SC-RT and LC-RCHT except an improved physical functioning in the LC-RCHT group (p=0.04). Comparing our total patient cohort with the general German population showed no difference in global health status but decreased QoL in several functional and bowel symptom scores. ConclusionsThe finding of comparable long-term QoL after SC-RT and LC-RCHT adds to our knowledge of equivalent oncological outcome and may be useful in the decision making process between the two neoadjuvant approaches.

Assessment of the quality of the pathological evaluation of total mesorectal excision specimens: Differences in evaluation between local pathologists and a review committee in the context of an improvement project.

481 Background: Data on quality control of the pathologic evaluation of total mesorectal excision specimens are scarce. Differences between evaluation by local pathologists participating in PROCARE, a Belgian improvement project on rectal cancer, and a review panel were assessed. Methods: Based on photographic material and histopathology slides, a review committee of pathologists with a particular interest in colorectal pathology re-evaluated the mesorectal plane, the circumferential resection margin (CRM), the tumour differentiation grade, the (y)pT stage and the tumour regression grade (according to Dworak) in 444 cases (354 low anterior resection and 90 abdomino-perineal resection specimens). Results: The surgical plane was reported in 89% and the CRM in 88% of cases by the local pathologist. The median number of lymph nodes harvested in patients undergoing long-course neoadjuvant radiochemotherapy was 11, whereas this was 14 in the other patients. The review committee downgraded the surgical plane of 17% of patients from (intra)mesorectal to intramuscular, and upgraded it in 27% from intramuscular to (intra)mesorectal. Tumour differentiation grade, T stage and tumour regression grade differed between local pathologists and review committee in 15%, 10% and 38%, respectively. T stage was upgraded in 8% of cases, mainly from T2 to T3. Tumour regression was judged by the review panel to be less advanced in 15% of cases. Conclusions: Acknowledging some shortcomings (comparison between a photographical evaluation and an evaluation on a fresh specimen), this study gives a realistic view of clinical practice. There are differences in interpretation with regard to macroscopic and microscopic analysis of TME specimens. These findings indicate a need for more objective and reproducible criteria in histopathology. Being aware of this is a first step for improvement.

Next-generation, genome- and mutational landscape heterogeneity-based novel biomarkers for personalized neoadjuvant treatment and laparoscopic rectal cancer resection

Based on previous phase 3 randomized clinical trials suggesting patient’s benefits, preoperative chemoradiotherapy has become popular for selected patients with advanced (T3, T4 tumors or node-positive) rectal cancer. However, meta-analyses published this year reporting data from recent phase 3 trials raise concerns on the clinical utility of this neoadjuvant chemoradiotherapy [1, 2]. Preoperative tumor responsiveness to this treatment was approximately 40–50 %, and the overall resistance and complications rates balanced with the benefits. These latest clinical results reveal the urgent need of biomedical research for developing robust biomarkers for tailoring neoadjuvant treatment to sensitive tumors only and explain the recent focus of next-generation sequencing (NGS)-based biomarkers [3, 4]. Although ideally laparoscopic rectal surgery should follow neoadjuvant treatment in selected patients with predictable tumor responsiveness, it is important to obtain data evaluating the impact of this preoperative multimodal treatment in the safety and efficacy of subsequent laparoscopic surgery. Therefore, either using conventional or novel genome-based selection criteria this information is important for laparoscopic surgeons. This clinically crucial question is highlighted by Denost et al. [5] in the July issue of Surgical Endoscopy. Of 422 patients treated by laparoscopic rectal excision with sphincter preservation, 292 received preoperative radiotherapy, and 130 had primary surgery. There was no significant difference in mortality rate between radiotherapy group (0.3 %) and surgical group (0.8 %). No significant difference was observed with respect to the rates of conversion (19 vs. 15 %), overall morbidity (37 vs. 29 %), surgical morbidity (20 vs. 18 %), or anastomotic leakage (13 vs. 11 %). Preoperative radiotherapy had no impact on conversion or surgical morbidity. The authors conclude that long-course radiochemotherapy (45 Gy during 5 weeks) does not influence the feasibility or short-term outcome of laparoscopic sphincter-saving rectal excision for rectal cancer. This study by Denost et al. [5] is limited by its retrospective nature. But despite that that there were more advanced and lower tumors with lower anastomosis in the neoadjuvant group, there was no significant difference between the groups suggesting the safety of laparoscopic surgery after preoperative adjuvant chemoradiotherapy. Anastomotic leakage and morbidity rates reported in this study are within the ranges of current papers suggesting the task to reduce anastomotic leakage rate substantially lower than 10 %. Despite advances with minimally invasive surgery for gastrointestinal cancer [6–13], cancer biology still remains a scientific mystery explaining the failure of biomedical research to discover robust biomarkers to accurately predict responsiveness or resistance to currently used adjuvant multimodal treatment. Resistance is even today a major problem and despite initial enthusiasm with anti-EGFR antibodies, such as cetuximab or panitumumab, more recent well-designed and conducted phase 3 randomized clinical found no survival benefit for selected, wild-type KRAS metastatic, or adjuvant colorectal cancer [14, 15]. Patient-to-patient and intratumor heterogeneity has been confirmed by using NGS and represent a step forward to understand the complexity of cancer genome and the slow progress to discover robust biomarkers for driving a combination of drugs effective to individual responder patients. Indeed, whole-exome sequencing (WES), whole-genome C. Hottenrott (&) Chirurgische Klinik, St. Elisabethenkrankenhaus, Ginnheimer Strase 3, 60487 Frankfurt, Germany e-mail: info@gastricbreastcancer.com

614P - Neoadjuvant Treatment in Rectal Cancer: Long- VS Short-Course Radiotherapy

ABSTRACT Introduction Two schemes for pre-operative radiotherapy (RT) in locally advanced rectal carcinoma (RC) are possible: long-course irradiation (45 – 50.4 Gy / 25 – 28 fr) with chemotherapy (CHT), followed by surgery after 6 to 8 weeks; and short-course irradiation (25 Gy / 5 fr), followed by surgery usually 1 week after. Some studies have shown a downstaging effect with delayed surgery in short-course irradiation Goal: Compare results of different irradiation schemes for neoadjuvant treatment of RC in a Radiation Oncology Department. Methods Patients with RC treated pre-operatively between 2002 and 2012 were included. RT was performed according to 2 schemes: long-course scheme (GROUP 1) using only RT (GROUP 1A), with oral CHT (GROUP 1B) or infusion CHT (GROUP 1C); and short-course scheme (GROUP 2). Results 265 patients were included, 227 in GROUP 1. GROUP 1A were older than GROUP 1B and 1C (p 1 week) there were significant differences in locoregional response (28.6% vs 75.0%, p = 0.033), with 2 complete responses in those with greater time to surgery. Conclusions These results are according to literature: long-course scheme with concomitant CHT provided better locoregional response, although with some acute toxicity; a higher time to surgery in short-course scheme appears to have better results, with no increase in surgical complications. Short-course irradiation with surgery delay appears to be a useful alternative to long-course radiochemotherapy, namely in patients with advanced age and associated comorbidities. Disclosure All authors have declared no conflicts of interest.

Comparison of preoperative short-course radiotherapy and long-course radiochemotherapy for locally advanced rectal cancer

The purpose of this work was to perform a single institution comparison between preoperative short-course radiotherapy (SC-RT) and long-course radiochemotherapy (LC-RCHT) for locally advanced rectal cancer. A total of 225patients with clinical stage UICC II-III rectal cancer were treated with SC-RT (29Gy in 10 twice daily fractions followed by immediate surgery; n = 108) or LC-RCHT (54Gy in 28 fractions with simultaneous 5-fluorouracil (5-FU) ± oxaliplatin chemotherapy followed by delayed surgery; n = 117). All patients in the LC-RCHT cohort and patients in the SC-RT with pathological UICC stage ≥ II received adjuvant chemotherapy. Before 2004, the standard of care was SC-RT with LC-RCHT reserved for patients where downstaging was considered as required for sphincter preservation or curative resection. In the later period, SC-RT was practiced only for patients unfit for radiochemotherapy. Patients in the LC-RCHT cohort had a significantly higher proportion of cT4 tumors, clinical node positivity, and lower tumor location. The 5-year local control (LC) and overall survival (OS) were 91% and 66% without differences between the SC-RT and LC-RCHT groups. Acute toxicity was increased during LC-RCHT (grade ≥ II 1% vs. 33%) and there were no differences in postoperative complications. Severe late toxicity grade ≥ III was increased after SC-RT (12% vs. 3%). Of patients aged > 80years, 7 of 7patients and 4 of 9patients received curative surgery after SC-RT and LC-RCHT, respectively. Despite the fact that patients with worse prognostic factors were treated with LC-RCHT, there were no significant differences in LC and OS between the SC-RT and LC-RCHT group. Age > 80years was identified as a significant risk factor for LC-RCHT and these patients could be treated preferably with SC-RT.

Laparoscopic surgery for rectal cancer: preoperative radiochemotherapy versus surgery alone

A few studies have suggested advantages of laparoscopic surgery for rectal cancer. However, the role of laparoscopy has not been clearly defined specifically in cases after neoadjuvant radiochemotherapy. This study aimed to assess the impact of preoperative radiotherapy on the feasibility of laparoscopic rectal excision with sphincter preservation for rectal cancer. From 1999 to 2010, the authors considered all patients treated by laparoscopic rectal excision with sphincter preservation for rectal cancer. Patients treated by long-course preoperative radiochemotherapy (45 Gy during 5 weeks) were compared with those treated by surgery alone. The end points of the study were mortality, conversion, and overall and surgical morbidity. Among 422 patients treated by laparoscopic conservative rectal excision, 292 received preoperative radiotherapy, and 130 had surgery alone. The two groups were similar in sex, age, body mass index, and American Society of Anesthesiologists (ASA) score. The mortality rate was 0.3% in the radiotherapy group and 0.8% in the surgical group (P = 0.52). The two groups did not differ in terms of conversion (19 vs. 15%; P = 0.39), overall morbidity (37 vs. 29%; P = 0.14), surgical morbidity (20 vs. 18%; P = 0.60), or anastomotic leakage (13 vs. 11%; P = 0.54). Multivariate analysis showed male gender and synchronous metastasis as independent factors of surgical morbidity. The independent factors of conversion were male gender, obesity, tumor stage, and type of anastomosis. Preoperative radiotherapy influenced neither conversion nor surgical morbidity. Long-course radiochemotherapy does not have an impact on the feasibility or short-term outcome of laparoscopic conservative rectal excision for rectal cancer.

Rektumkarzinom: Behandeln wir zu häufig neoadjuvant? Vorschläge zu einer selektiveren, MRT-basierten Indikation

The present-day optimised surgery (concept of total mesorectal excision) with quality assurance by standardized pathologic examination, advances in radiotherapy and the possibilities of high-spatial-resolution MR imaging require reconsideration of pros and contras of neoadjuvant therapy and respective data. According to the resulting new proposal neoadjuvant long-course radiochemotherapy is indicated for patients with 1) fixed questionably R0 resectable tumors, 2) mobile tumors with the MRT finding of tumor involving the mesorectal fascia or 1 mm or less from it, 3) low rectal tumors extending below the levator origin and invading beyond the muscularis propria. If a high risk of local recurrence becomes apparent during surgery (tumor perforation, incision into or through tumor) or after pathologic examination (incomplete mesorectal excision, tumor 1 mm or less from the circumferential resection margin) adjuvant radiochemotherapy is indicated. In case of lymph node metastasis postoperative chemotherapy is given.