Combination of chemotherapy and radiotherapy prior to surgery of rectum cancer darmkanker-bung gives significantly better results on the tumor size and metastases lymfklier in advance in the operation only irradiation thus large randomized phase III study.
30 november 2005: source: J Clin Oncol. 2005; 23: 5620-5627 and Clinical Options.
A large long-year randomized European phase III study confirms that when interoperable rectum kankerpatiënten in advance to get the operation chemo and radiation the tumors in operation were smaller, less lymfklieruitzaaiïngen and easier to operate. The researchers stress that the effect on the tumour size etc. no evidence that this approach also for longer-lasting survival or more overlevingen. Here an article about this study of Clinical Options.
Preoperative chemoradiotherapy superior to radiotherapie alone in patients with rectal cancer
By Mindy Tanzola
November 01, 2005
Patients treated with preoperative chemoradiotherapy (RT-CT) exhibited superior histologic and pathologic characteristics at the time of surgery compared with those receiving radiotherapie (RT) alone, according to a recent study published in the Journal of Clinical Oncology.
Over the past several decades, much controversy has surrounded the issue of neoadjuvant and adjuvant therapies in the treatment of colorectal cancer. In 1989, the National Institutes of Health recommended postoperative RT-CT as standard treatment for patients with stage II or III rectal cancer.
Subsequent studies indicated a potential benefit for preoperative RT-CT, which led to the wide acceptance of this approach in the United States. However, preoperative RT alone has remained the standard treatment approach in Europe.
These treatment approaches have not been compared in a large-scale randomized trial. For this reason, the European Organisation for Research and Treatment of Cancer (EORTC) launched the current 22921 trial.
Jean-Francois Bosset, MD, of the Besançon University Hospital, France, and colleagues enrolled 1011 patients with T3 or T4 resectable rectal adenocarcinoma to receive preoperative RT (45 Gy over 5 weeks) with or without chemotherapy (n = 505) consisting of two 5-day courses or 350 mg/m2/day or fluorouracil plus leucovorin 20 mg/m2/day or given concurrently during Weeks 1 and 5 or RT.
The tumor was resected subsequently in 476 and 473 patients in the RT and RT-CT groups, respectively. Patients treated with RT-CT had smaller tumors compared with RT-treated patients (mean size, 25.0 mm vs 30.0 mm; P ≪. 001). They also showed significantly lower tumor stage (P ≪. 001) and had significantly less lymph node involvement (P ≪. 001). Histologically, specimens from patients treated with RT-CT were less likely to demonstrate lymphatic, venous, or perineural invasion (P ≤. 001 for each) compared with RT-treated patients.
However, the researchers caution that these results are preliminary. They also point out that the "observed enhanced tumoricidal effects or RT-CT should in no case be regarded as a surrogate indication for a longer-termtreatment effect on survival or locoregional control. "
Patients are being further randomized to postoperative chemotherapy vs observation. According to the researchers, subsequent follow-up should provide important information regarding potential benefits of chemotherapy and/or RT at different stages of treatment for rectal cancer.
Reference
Bosset JF, Calais G, Minor L, et al. Enhanced tumorocidal effect of preoperative chemotherapy on rectal cancer radiotherapie by adding: preliminary results from the European Organization for Research and Treatment of Cancer 22921 randomized trial. J Clin Oncol. 2005; 23: 5620-5627.
