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Neoadjuvant Radiotherapy in Stage I Cancer of the Lower Rectum

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DOI: 10.4236/jct.2014.56064    3,210 Downloads   4,432 Views  

ABSTRACT

Introduction: The mortality rate in cancer of the lower rectum is related to the incidence of local recurrence, in the first 5 years. For stage I tumors, local excision has being increasingly used, but recent studies showed a higher incidence rate of local recurrence. Therefore, preoperative radiotherapy should be considered even for these tumors, as an attempt to prevent recurrence and provide cure. Objective: To show the effectiveness of neoadjuvant radiotherapy in stage I cancer of the lower rectum of a cohort population. Materials and Method: A cohort study in a prospective database was made with a total of 75 patients considered as stage I cancer of the lower rectum. Preoperative long course of 4500 cG radiotherapy was performed in this selected group of patients and followed up for a minimum period of five years. Results: Stage I/TI group had 27 patients. All of them presented complete response to the treatment and did not need to be submitted to surgery. Five years follow up with no recurrence. The stage I/TII group had 48 patients. After neoadjuvant radiotherapy, 8 patients had to be submitted to surgery for persistent tumor. All were submitted to full total local excision (FTLE), but anatomopathological examination showed no residual cancer. Conclusion: Preoperative long course of 4500 cG irradiation, not only reduced the local recurrence and mortality rate in lower rectal cancer, but also reduced indication for surgery in patients with stage I cancer of the lower rectum.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Junior, A. , Espinoza, G. , Oliveira, L. , Banci, S. , Neto, J. , Kagohara, O. , Junior, J. and Neto, J. (2014) Neoadjuvant Radiotherapy in Stage I Cancer of the Lower Rectum. Journal of Cancer Therapy, 5, 560-564. doi: 10.4236/jct.2014.56064.

References

[1] Reis Neto, J.A., Reis Jr., J.A., Kagohara, O., Simoes Neto, J., Banci, S.O. and Oliveira, L.H. (2012) Adjuvant Therapy on Cancer of the Lower Rectum. Evaluation of the Effects of Preoperative Radiotherapy on the Prognosis of Patients with Cancer of the Lower Rectum. Journal of Cancer Therapy, 3, 912-919. http://dx.doi.org/10.4236/jct.2012.326117
[2] Fichera, A. and Allaix, M.E. (2013) Paradigm-Shifting New Evidence for Treatment of Rectal Cancer. Journal of Gastrointestinal Surgery, 18, 391-397.
[3] Das, P. and Crane, C.H. (2009) Staging, Prognostic Factors, and Therapy of Localized Rectal Cancer. Current Oncology Reports, 11, 167-174. http://dx.doi.org/10.1007/s11912-009-0025-3
[4] Kachnic, L.A. (2007) Adjuvant Chemoradiation for Localized Rectal Cancer: Current Trends and Future Directions. Gastrointestinal Cancer Research, 1, 64-72.
[5] Sauer, R. (2002) Adjuvant and Neoadjuvant Radiotherapy and Concurrent Radiochemotherapy for Rectal Cancer. Pathology & Oncology Research, 8, 7-17. http://dx.doi.org/10.1007/BF03033695
[6] Wagner, T.D., Fakih, M.G. and Yang, G.Y. (2010) Management of Stage II/III Rectal Cancer. Journal of Gastrointestinal Oncology, 1, 112-119.
[7] Sauer, R. and Rodel, C. (2002) Adjuvant and Neoadjuvant Radiochemotherapy of Rectal Carcinoma. Praxis, 91, 1476- 1484.
http://dx.doi.org/10.1024/0369-8394.91.37.1476
[8] Pucciarelli, S., Capirci, C., Emanuele, U., Toppan, P., Friso, M.L., Pennelli, G.M., Crepaldi, G., Pasetto, L., Nitti, D. and Lise, M. (2005) Relationship between Pathologic T-Stage and Nodal Metastasis after Preoperative Chemoradiotherapy for Locally Advanced Rectal Cancer. Annals of Surgical Oncology, 12, 111-116. http://dx.doi.org/10.1245/ASO.2005.03.044
[9] Loos, M., Quentmeier, P., Schuster, T., Nitsche, U., Gertler, R., Keerl, A., Kocher, T., Friess, H. and Rosenberg, R. (2013) Effect of Preoperative Radio (Chemo) Therapy on Long-Term Functional Outcome in Rectal Cancer Patients: A Systematic Review and Meta-Analysis. Annals of Surgical Oncology, 20, 1816-1828. http://dx.doi.org/10.1245/s10434-012-2827-z
[10] Kulu, Y., Ulrich, A. and Büchler, M.W. (2012) Resectable Rectal Cancer: Which Patient Does Not Need Preoperative Radiotherapy? Digestive Disease, 30, 118-125. http://dx.doi.org/10.1159/000342040
[11] Rodel, C., Trojan, J., Bechstein, W.-O. and Woeste, G. (2012) Neoadjuvant Short- or Long-Term Radio(Chemo)- Therapy for Rectal Cancer: How and Who Should Be Treated? Digestive Disease, 30, 102-108. http://dx.doi.org/10.1159/000342038
[12] Kim, D.J. and Jung, K.H. (2006) Radiation Therapy for Rectal Cancer. The Korean Journal of Gastroenterology, 47, 285-290.
[13] Quirk, P., Steele, R., Monson, J., Grieve, R., Khanna, S., Couture, J., O’Callaghan, C., Myint, A.S., Bessell, E., Thomp-son, L.C., Parmar, M., Stephens, R.J. and Sebag-Montefiore, D. (2009) Effect of the Plane of Surgery Achieved on Local Recurrence in Patients with Operable Rectal Cancer: A Prospective Study Using Data from the MRC CR07 and NCIC-CTG CO16 Randomized Clinical Trial. Lancet, 373, 821-828. http://dx.doi.org/10.1016/S0140-6736(09)60485-2
[14] Sebag-Montefioreet, D., Stephens, R.J., Steele, R., Monson, J., Grieve, R., Khanna, S., Quirke, P., Couture, J., de Metz, C., Myint, A.S., Bessell, E., Griffiths, G., Thompson, L.C. and Parmar, M. (2009) Preoperative Radiotherapy versus Selective Postoperative Chemoradiotherapy in Patients with Rectal Cancer (MRC CR07 and NCIC-CTG C016): A Multicentre, Randomized Trial. Lancet, 373, 811-820. http://dx.doi.org/10.1016/S0140-6736(09)60484-0
[15] Garcia-Aguilar, J., Mellgren, A. and Rothenberger, D.A. (2000) Local Excision of Rectal Cancer without Adjuvant Therapy. Annals of Surgery, 231, 345-351.
http://dx.doi.org/10.1097/00000658-200003000-00007
[16] Sengupta, S. and Tiandra, J.J. (2001) Local Excision of Rectal Cancer: What Is the Evidence? Diseases of the Colon & Rectum, 44, 1345-1361. http://dx.doi.org/10.1007/BF02234796
[17] Phillip, P., Nash, G.M. and Wong, W.D. (2002) Long-Term Results of Local Excision for Rectal Cancer. Annals of Surgery, 236, 522-530. http://dx.doi.org/10.1097/00000658-200210000-00015
[18] Stipa, F., Lucandri, G., Ferri, M., Casula, G. and Ziparo, V. (2004) Local Excision of Rectal Cancer with Transanal Endoscopic Microsurgery (TEM). Anticancer Research, 24, 1167-1172.
[19] Suppiah, A., Hunter, I.A., Cowley, J., Garimella, V., Cast, J., Hartley, J.E. and Monson, J.R.T. (2009) Magnetic Resonance Imaging Accuracy in Assessing Tumor Down-Staging following Chemoradiation in Rectal Cancer. Colorectal Disease, 11, 249-253.
[20] Bebenek, M., Pude?ko, M., Cisar?, K., Balcerzak, A., Tupikowski, W., Wojciechowski, L., Stankowska, A., Tarkowski, R. and Szulc, R. (2007) Therapeutic Results in Low-Rectal Cancer Patients Treated with Abdominosacral Resection Are Similar to Those Obtained by Means of Anterior Resection in Mid- and Upper-Rectal Cancer Cases. European Journal of Surgical Oncology, 33, 320-333.
http://dx.doi.org/10.1016/j.ejso.2006.09.012?
[21] Lezoch, E., Guerrieri, M., Paganini, A.M., D’Ambrosio, G., Baldarelli, M., Lezoche, G., Feliciotti, F. and De Sanctis, A. (2005) Transanal Endoscopic versus Total Mesorectal Laparoscopic Resections of T2-N0 Low Rectal Cancers after Neoadjuvant Treatment. Surgical Endoscopy, 19, 751-756.
http://dx.doi.org/10.1007/s00464-004-8930-x
[22] Lezoch, G., Baldarelli, M., Guerrieri, M., Paganini, A.M., De Sanctis, A., Bartolacci, S. and Lezoche, E. (2008) A Prospective Randomized Study with a 5-Year Minimum Follow-Up Evaluation of Transanal Endoscopic Microsurgery versus Laparoscopic Total Mesorectal Excision after Neoadjuvant Therapy. Surgical Endoscopic, 22, 278. http://dx.doi.org/10.1007/s00464-007-9714-x
[23] Habr-Gama, A., Perez, R.O., Lynn, P.B., Neto, A.S. and Gama-Rodrigues, J. (2011) Nonoperative Management of Distal Rectal Cancer after Chemoradiation: Experience with the “Watch & Wait” Protocol. In: Santoro, G.A., Ed., Rectal Cancer, a Multidisciplinary Approach to Management, InTech, Sao Paulo, Chapter 17. http://dx.doi.org/10.5772/1293
[24] Reis Neto, J.A., Quilici, F.A. and Reis, J.A. (1989) A Comparison of Nonoperative vs. Preoperative Radiotherapy in Rectal Carcinoma: A 10-Year Randomized Trial. Diseases of the Colon & Rectum, 32, 702-710. http://dx.doi.org/10.1007/BF02555778
[25] Reis Neto, J.A., et al. (2000) Long-Term Results of Preoperative Radiotherapy for Cancer of the Lower Rectum. In: Reis Neto, J.A., Ed., New Trends in Coloproctology, Revinter, Sao Paulo, 401-410.
[26] Reis Neto, J.A., Quilici, F.A., Cordeiro, F., Ciquini, S. and Reis Jr., J.A. (1999) Pre-Operative Radiotherapy in Rectal Cancer: Evaluation of Irradiation Effects on Cellular Undifferentiation and Its Influence on Prognosis. Hepato-Gastroenterology, 46, 2825-2830.
[27] Reis Neto, J.A., et al. (2000) Preoperative Radiotherapy in Cancer of the Lower Rectum. Monduzzi, Colon, 67-74.
[28] Reis Neto, J.A., et al. (2001) Pre-Operative Radiotherapy and Laparoscopic Total Mesorectum Excision: Is There Any Improvement? Proktologia, 3, 141-142.
[29] Papillon, J. (1984) New Prospects in the Conservative Treatment of Rectal Cancer. Diseases of the Colon and Rectum, 27, 566-567. http://dx.doi.org/10.1007/BF02554589
[30] Papillon, J. (1980) Rectal and Anal Cancer. Springer-Verlag, Berlin, 24-32.

  
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