Skip to main content
SpringerLink
Log in

When Should Radiation Be Avoided in the Treatment of Rectal Cancer?

  • Chapter
  • First Online:
Multidisciplinary Management of Rectal Cancer

  • 969 Accesses

Abstract

The National Cancer Institute (NCI) Consensus Conference concluded in 1990 that chemotherapy plus concurrent radiation (chemoradiation) was the standard postoperative adjuvant treatment for all patients with pT3 and/or N1-2 rectal cancer [1]. This recommendation was based on phase III trials that compared postoperative chemoradiation arms with control arms of either surgery alone or surgery plus postoperative irradiation (Mayo/NCCTG 79-47-51) and demonstrated improvements in both disease-free and overall survival [2]. The standard design in US trials was to deliver six cycles of bolus 5-fluorouracil (5-FU)–based chemotherapy; concurrent irradiation was also given during cycles 3 and 4.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. (1990) National Institutes of Health consensus conference: adjuvant therapy for patients with colon and rectal cancer. J Am Med Assoc 264:1444–1450

    Google Scholar 

  2. Krook JE, Moertel CG, Gunderson LL et al (1991) Effective surgical adjuvant therapy for high-risk rectal carcinoma. N Engl J Med 324:709–715

    Article  CAS  PubMed  Google Scholar 

  3. Sauer R, Becker H, Hohenberger P et al (2004) Preoperative chemoradiotherapy as compared with postoperative chemoradiotherapy for locally advanced rectal cancer. New Engl J Med 351:11–20

    Article  Google Scholar 

  4. Green FL, Stewart AK, Norton HJ (2004) New tumor-node-metastasis staging system for node-positive (stage III) rectal cancer: an analysis. J Clin Oncol 22:1778–1784

    Article  Google Scholar 

  5. Nissan A, Stojadinovic A, Shia J et al (2006) Predictors of recurrence in patients with T2 and early T3, N0 adenocarcinoma of the rectum treated with surgery alone. J Clin Oncol 24:4078–4084

    Article  PubMed  Google Scholar 

  6. Kim JH, Beets GL, Kim MJ et al (2004) High-resolution MR imaging for nodal staging in rectal cancer: are there any criteria in addition to the size? Eur J Radiol 52:78–83

    Article  PubMed  Google Scholar 

  7. Leibold T, Shia J, Ruo L et al (2008) Prognostic implications of the distribution of lymph node metastasis rectal cancer after neoadjuvant chemotherapy. J Clin Oncol 26:2106–2111

    Article  PubMed  Google Scholar 

  8. Guillem JG, Diaz-Gonzalez J, Minsky BD et al (2008) cT3N0 rectal cancer: potential overtreatment with preoperative chemoradiotherapy is warranted. J Clin Oncol 26:368–373

    Article  PubMed  Google Scholar 

  9. Mendenhall WM, Bland KI, Rout WR et al (1988) Clinically resectable adenocarcinoma of the rectum treated with preoperative irradiation and surgery. Dis Colon Rectum 31:287–290

    Article  CAS  PubMed  Google Scholar 

  10. Schrag D, Weiser MR, Goodman KA et al (2014) Neoadjuvant chemotherapy without routine use of radiation therapy for patients with locally advanced rectal cancer: a pilot trial. J Clin Oncol 32:513–518

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Patel UB, Brown G, Machado I et al (2017) MRI assessemnt and outcomes in patients receiving neoadjuvant chemotherapy only for primary rectal cancer: long term results of the GEMCAD 0801 trial. Ann Oncol 28:344–353

    Google Scholar 

  12. Nagtegaal ID, Quirke P (2008) What is the role for the circumferential margin in the modern treatment of rectal cancer? J Clin Oncol 26:303–312

    Article  PubMed  Google Scholar 

  13. Nagtegaal ID, van de Velde CJH, Marijnen CAM et al (2005) Low rectal cancer: a call for a change of approach in abdominoperineal resection. J Clin Oncol 23:9257–9264

    Article  PubMed  Google Scholar 

  14. Bail SH, Kim NK, Lee YC et al (2007) Prognostic significance of circumferential resection margin following total mesorectal excision and adjuvant chemoradiotherapy in patients with rectal cancer. Ann Surg Oncol 14:462–469

    Article  Google Scholar 

  15. Al-Sukhni E, Milot L, Fruitman M et al (2012) Diagnostic accuracy of MRI for assessment of T category, lymph node metastasis, and circumferential resection margin involvement in patients with rectal cancer: a systematic review and meta-analysis. Ann Surg Oncol 19:2212–2223

    Article  PubMed  Google Scholar 

  16. Patel UB, Taylor F, Blomqvist L et al (2011) Magnetic resonance imaging-detected tumor response for locally advanced rectal cancer predicts survival outcomes: MERCURY experience. J Clin Oncol 29:3753–3760

    Article  PubMed  Google Scholar 

  17. Sebag-Montefiore D, Stephens RJ, Steele R et al (2009) Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicenter, randomised trial. Lancet 373:811–820

    Article  PubMed  PubMed Central  Google Scholar 

  18. Marijnen CAM, Nagtegaal ID, Kapiteijn E et al (2003) Radiotherapy does not compensate for positive resection margins in rectal cancer patients: report of a multicenter randomized trial. Int J Radiat Oncol Biol Phys 55:1311–1320

    Article  CAS  PubMed  Google Scholar 

  19. Peeters KCMJ, Marijnen CAM, Nagtegaal ID et al (2007) The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg 246:693–701

    Article  PubMed  Google Scholar 

  20. Birgisson H, Pahlman L, Glimelius B (2005) Adverse effects of preoperative radiation therapy for rectal cancer: long-term follow-up of the Swedish rectal cancer trial. J Clin Oncol 23:8697–8705

    Article  PubMed  Google Scholar 

  21. Bujko K, Nowacki MP, Nasierowska-Guttmejer A et al (2006) Long term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer. Br J Surg 93:1215–1223

    Article  CAS  PubMed  Google Scholar 

  22. Sauer R, Roedel C (2005) The author’s reply. New Engl J Med 352:510–511

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 97, Houston, TX, 77030, USA

    Bruce D. Minsky MD

Authors
  1. Bruce D. Minsky MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bruce D. Minsky MD .

Editor information

Editors and Affiliations

  1. Dept. of Radiation Oncology, UniversitĂ  Cattolica S Cuore, Rome, Italy

    Vincenzo Valentini

  2. Head, Div. Clinical Oncology Research, University Clinic Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle, Sachsen-Anhalt, Germany

    Hans-Joachim Schmoll

  3. Department of Surgery, Leiden Univ Med Ctr, Leiden, The Netherlands

    Cornelis J. H. van de Velde

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer-Verlag Berlin Heidelberg

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Minsky, B.D. (2018). When Should Radiation Be Avoided in the Treatment of Rectal Cancer?. In: Valentini, V., Schmoll, HJ., van de Velde, C. (eds) Multidisciplinary Management of Rectal Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-43217-5_19

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-43217-5_19

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-43215-1

  • Online ISBN: 978-3-319-43217-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation