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Neoadjuvant treatment intensification or adjuvant chemotherapy for locally advanced carcinoma rectum : the optimum treatment approach remains unresolved
Joint Authors
Benson, Rony
Mallick, Supriya
Haresh, K. P.
Rath, G. K.
Source
Journal of the Egyptian National Cancer Institute
Issue
Vol. 27, Issue 4 (31 Dec. 2015), pp.179-185, 7 p.
Publisher
Cairo University National Cancer Institute
Publication Date
2015-12-31
Country of Publication
Egypt
No. of Pages
7
Main Subjects
Topics
Abstract EN
Background : Rectal carcinoma [RC] is often managed with preoperative radiotherapy or radio-chemotherapy followed by total mesorectal excision (TME).
Efforts are being made to improve outcome by intensifying the preoperative treatment.
However, the optimum therapy remains unclear.
There is ongoing controversy regarding the optimum radiation dose, chemotherapy regimen and schedule.
In addition there exists growing disagreement regarding the role of adjuvant chemotherapy after neoadjuvant radiation or chemoradiation.
Methodology: We reviewed the recent land mark trials to find a road map in the management of locally advanced rectal carcinoma.
Results: Preoperative short course radiotherapy has long been proven to improve local disease control.
The initial trials with long course chemoradiotherapy, comparing short course radiotherapy have shown to increase local control and pathological complete response rates.
Since then treatment intensification of this neoadjuvant schedule has been tried by many researchers.
But initial results of these treatment intensification trials, show no significant benefit and are associated with increased toxicity.
There is an unmet need to stratify patients depending on risk to assign them to long course chemoradiotherapy or short course radiotherapy.
Current evidence does not support the use of adjuvant chemotherapy in patients who were treated with preoperative (chemo)radiotherapy.
Conclusion: Preoperative radiotherapy appears to improve disease control with favorable toxicity profile and there is very little to choose between long course chemoradiotherapy and short course radiotherapy.
However, long course chemoradiotherapy may be beneficial for patients with high risk features like positive circumferential resection margin [CRM] and extramural spread of >5 mm.
There is no role for adjuvant chemotherapy in patients who were treated preoperative (chemo)radiotherapy.
American Psychological Association (APA)
Mallick, Supriya& Benson, Rony& Haresh, K. P.& Rath, G. K.. 2015. Neoadjuvant treatment intensification or adjuvant chemotherapy for locally advanced carcinoma rectum : the optimum treatment approach remains unresolved. Journal of the Egyptian National Cancer Institute،Vol. 27, no. 4, pp.179-185.
https://search.emarefa.net/detail/BIM-648695
Modern Language Association (MLA)
Mallick, Supriya…[et al.]. Neoadjuvant treatment intensification or adjuvant chemotherapy for locally advanced carcinoma rectum : the optimum treatment approach remains unresolved. Journal of the Egyptian National Cancer Institute Vol. 27, no. 4 (Dec. 2015), pp.179-185.
https://search.emarefa.net/detail/BIM-648695
American Medical Association (AMA)
Mallick, Supriya& Benson, Rony& Haresh, K. P.& Rath, G. K.. Neoadjuvant treatment intensification or adjuvant chemotherapy for locally advanced carcinoma rectum : the optimum treatment approach remains unresolved. Journal of the Egyptian National Cancer Institute. 2015. Vol. 27, no. 4, pp.179-185.
https://search.emarefa.net/detail/BIM-648695
Data Type
Journal Articles
Language
English
Notes
Includes bibliographical references : p. 184-185
Record ID
BIM-648695