Journal Club. 17 th March, 2003 Dr Ramon Varcoe. Which rectal cancers should. be treated with . PREOPERATIVE RADIATION ?. Background… “ There is evidence to support the rationale of giving radiotherapy before surgery while the SI is mobile and not fixed in the pelvis with adhesions..”.
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17th March, 2003
Dr Ramon Varcoe
be treated with
PREOPERATIVE RADIATION ?
Swedish Rectal Cancer Trial. NEJM. 1997…
Camma etal. (meta-analysis) JAMA. 2000…
Camma etal. (meta-analysis) JAMA 2000…
Lopez-Kostner etal. (Cleveland) Surgery 1998…
Marsh etal. (Manchester) DCR 1994…
(ERUS is most sensitive for bowel wall invasion, 86% by Napoleon etal BJS 1991)
Most Trials therefore have LR 25-50% instead of the expected 4-9% with TME
Nb.The Dutch Colorectal Cancer Group Trial has since been published using TME and confirming the survival benefits seen in the Swedish trial
by C.Delaney, I.Lavery, A.Brenner, J.Hammel, A.Senagore, R.Noone and V.Fazio
Cleveland Clinic, Ohio, USA
Annals of Surgery
236(2), 2002, 203-7
40-50 Gy over 4-6 weeks then surgery 4-6 weeks later
Excision of the mesorectum with its investing fascial layer preserving the pre-sacral autonomic nerves and Denonvillier’s fascia
Cancer specific survival benefit also dominated by node negative tumours
Local recurrence rates were also marginally reduced with PRT
Show me the money
In the same group cancer specific survival is also significantly improved
This potential histology inaccuracy creates a crucial flaw in the study design
"Do we use long course
or short course radiation ?"