RefDoc
Haut

Faire une nouvelle recherche
Make a new search
Lancer la recherche


Titre du document / Document title

Sandwich preoperative and postoperative combined chemotherapy and radiation in tethered and fixed rectal cancer : Impact of treatment intensity on local control and survival

Auteur(s) / Author(s)

CHAN A. K. P. (1) ; WONG A. O. (2) ; LANGEVIN J. M. (3) ; JENKEN D. A. (3) ; KHOO R. (4) ; HEINE J. A. (5) ; BUIE W. D. (6) ; JOHNSON D. R. E. (3) ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

(1) Department of Radiation Oncology, Tom Baker Cancer Centre, Southern Alberta Cancer Program and University of Calgary, Calgary, Alberta, CANADA
(2) Department of Medicine, Tom Baker Cancer Centre, Southern Alberta Cancer Program and University of Calgary, Calgary, Alberta, CANADA
(3) Department of Surgery, Rockyview Hospital, University of Colorado, Denver, CO, ETATS-UNIS
(4) Department of Surgery, University of Colorado, Denver, CO, ETATS-UNIS
(5) Department of Surgery, Calgary General Hospital, Calgary, Alberta, CANADA
(6) Department of Surgery, Foothills Hospital, Calgary, Alberta, CANADA

Résumé / Abstract

Purpose: The present sandwich preoperative and postoperative chemotherapy and radiation study was undertaken to evaluate the impact of treatment intensity on the local control and survival in tethered or fixed rectal adenocarcinoma (T3, 4 NX M0). Methods and Materials: Between 1990 and 1992, 27 patients were treated with this sandwich protocol. Preoperative therapy consisted of 4 weeks of concurrent radiation (40 Gy) and chemotherapy (mitomycin C on day 1, 5-fluorouracil infusion and leucovorin on days 1-4 and days 15-18, respectively), and one cycle of bolus 5-fluorouracil and leucovorin chemotherapy. After surgery, they received 2 additional weeks of radiation (18 Gy) and 4 days of similar chemotherapy. The outcome was compared to another 54 patients who were treated with our previous preoperative chemoradiation protocol (mitomycin C, 5-fluorouracil infusion and 40 Gy of pelvic RT). Results: The complete resectability rate was improved from 91% in the preoperative protocol to 100% in the sandwich protocol, and the pathologic complete response rate (T0 N0 M0) was increased from 4 to 15%. There was no local recurrence in the sandwich protocol. The 4-year local failure rate was 23 vs. 0% (p = 0.005). The 4-year distant failure rate was 47 vs. 28% (p = 0.079). The 2-year and 4-year survival were 63 and 41% for the preoperative protocol, vs. 92 and 72% for the sandwich protocol, respectively (p = 0.014). There were more treatment-related Grade 2 diarrhea, but not Grade 3/4 diarrhea in the sandwich protocol. Two patients (7%) in the sandwich protocol developed late gastrointestinal complications. Conclusions: More intensive radiation and chemotherapy appeared to improve the resectability, local control, and survival in tethered and fixed rectal cancers. There was a moderate but acceptable increase in the bowel morbidity.

Revue / Journal Title

International journal of radiation oncology, biology, physics    ISSN  0360-3016   CODEN IOBPD3 

Source / Source

1997, vol. 37, no3, pp. 629-637 (39 ref.)

Langue / Language

Anglais

Editeur / Publisher

Elsevier, New York, NY, ETATS-UNIS  (1975) (Revue)

Mots-clés anglais / English Keywords

Malignant tumor

;

Rectum

;

Human

;

Combined treatment

;

Radiotherapy

;

Chemotherapy

;

Treatment efficiency

;

Survival curve

;

Adenocarcinoma

;

Therapeutic protocol

;

Toxicity

;

Digestive diseases

;

Intestinal disease

;

Rectal disease

;

Mots-clés français / French Keywords

Tumeur maligne

;

Rectum

;

Homme

;

Traitement associé

;

Radiothérapie

;

Chimiothérapie

;

Efficacité traitement

;

Courbe survie

;

Adénocarcinome

;

Protocole thérapeutique

;

Toxicité

;

Appareil digestif pathologie

;

Intestin pathologie

;

Rectum pathologie

;

Mots-clés espagnols / Spanish Keywords

Tumor maligno

;

Recto

;

Hombre

;

Tratamiento asociado

;

Radioterapia

;

Quimioterapia

;

Eficacia tratamiento

;

Curva sobrevivencia

;

Adenocarcinoma

;

Protocolo terapéutico

;

Toxicidad

;

Aparato digestivo patología

;

Intestino patología

;

Recto patología

;

Localisation / Location

INIST-CNRS, Cote INIST : 17180, 35400006552724.0200

Nº notice refdoc (ud4) : 2659823



Faire une nouvelle recherche
Make a new search
Lancer la recherche
Bas