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Management of Rectal Cancer: Short- vs. Long-Course Preoperative Radiation
- Source :
- International Journal of Radiation Oncology*Biology*Physics. 72:636-643
- Publication Year :
- 2008
- Publisher :
- Elsevier BV, 2008.
-
Abstract
- There is considerable debate on the optimum approach to neoadjuvant therapy in rectal cancer. This review of major published studies of short-course preoperative radiation and the more conventional approach of long-course neoadjuvant chemoradiation was undertaken in an effort to understand the potential advantages and disadvantages of each of these approaches. Studies were evaluated with regard to patient selection, clinical outcomes, and toxicities. Short-course preoperative radiation has shown a clear advantage over surgery alone in reducing local recurrence rates and improving survival of patients with rectal cancer. However, studies using short-course preoperative treatment have included a significant number of early (30%; Stage I/II) and more proximal cancers yet appear to have higher positive margin rates, higher abdominoperineal resection rates, and lower aggregate survival than patients treated with long-course neoadjuvant chemoradiation. Although long-course preoperative chemoradiation is associated with higher rates of reversible acute toxicity, there appears to be more significant and a higher rate of late gastrointestinal toxicity observed in short-course preoperative radiation studies. Patient convenience and lower cost of treatment, however, can be a significant advantage in using a short-course treatment schedule. Selective utilization of either of these approaches should be based on extent of disease and goals of treatment. Patients with distal cancers or more advanced disease (T3/T4) appear to have better outcomes with neoadjuvant chemoradiation, especially where downstaging of disease is critical for more complete surgical resection and sphincter preservation.
- Subjects :
- Cancer Research
medicine.medical_specialty
Radiation
Positive margin
Rectal Neoplasms
business.industry
Abdominoperineal resection
Colorectal cancer
medicine.medical_treatment
Antineoplastic Agents
Disease
medicine.disease
Combined Modality Therapy
Survival Analysis
Surgery
Treatment Outcome
Oncology
Preoperative radiation
Humans
Medicine
Radiology, Nuclear Medicine and imaging
business
Survival analysis
Neoadjuvant therapy
Subjects
Details
- ISSN :
- 03603016
- Volume :
- 72
- Database :
- OpenAIRE
- Journal :
- International Journal of Radiation Oncology*Biology*Physics
- Accession number :
- edsair.doi.dedup.....ea8d7f18d1ca7794e74541be3b2b077f