Neoadjuvant Chemotherapy and Radiotherapy in Locally Advanced Rectal Carcinoma

Document Type : Original Article

Authors

1 Department of Clinical Oncology , Faculty of Medicine, Sohag University.

2 Department of surgical oncology, south Egypt cancer Institute.

3 Department of Clinical oncology, Faculty of Medicine, Sohag University, Sohag, Egypt.

4 Department of oncology, Faculty of Medicine, Sohag University.

Abstract

Background:
Neoadjuvant chemoradiotherapy has become the standard treatment for locally advanced rectal cancer. Neoadjuvant chemoradiotherapy not only can reduce tumor size and recurrence, but also increase the tumor resection rate and anus retention rate with very slight side effect. Comparing with preoperative chemotherapy alone, preoperative chemoradiotherapy can further reduce the local recurrence rate and downstage. Middle and low rectal cancers can benefit more from neoadjuvant chemradiotherapy than high rectal cancer.
Aim of the work:
1- Selection of suitable neoadjuvant chemoradiotherapy method with less acute and  late toxicity effect.
2- Discover which drug or combination of drugs have better results in terms of local recurrence and survival .
3- Selection of appropriate patients and irradiation modes for neoadjuvant chemoradiotherapy.
Methods:
Three major databases(PubMed,MEDLINE and Cochrane library).
The review included articles published in English in NCCN Journal and ASCO Journal from January 2012 t0 march 2018.
Conclusion:
 Preoperative chemoradiotherapy has been recommended as the standard treatment for locally advanced middle and low rectal cancer.

Main Subjects


1-ChungM,LeeJ,TerasawaT. Vitamin D with or without calcium supplementation for prevention of cancer and fractures: an updated meta-analysis for the U.S. Preventive Services Task Force. Ann Intern Med 2011; 155:82 “Updated protocol for the examination of specimens from patients with carcinomas of the colon and rectum, excluding carcinoid tumors, lymphomas, sarcomas, and tumors of the vermiform appendix:  a basis for checklists. Cancer Committee,” Archives of Pathology and Laboratory Medicine, vol. 124, no. 7, pp. 1016–1025, 2000.
 2- Tørring ML, Frydenberg M, Hansen RP. Time to diagnosis and mortality in colorectal cancer: a cohort study in primary care. Br J Cancer 2011; 104:934.
3-Cao S, Bhattacharya A, Durrani FA, Fakih M. Irinotecan, oxaliplatin and raltitrexed for the   treatment of advanced colorectal cancer. Expert Opinion on Pharmacotherapy. 2006.
4-Capirci C., Valentini V., Cionini L., De Paoli A., Rodel C., Glynne-Jones R., Coco C.,Romano M., Mantello G., Palazzi S., Osti M.F., Friso M.L., Genovesi D., Vidali C.,Gambacorta M.A., Buffoli A., Lupattelli M., Favretto M.S. & LaTorre G. (2008)Prognostic value of pathologic complete response after neoadjuvant therapy in locally advanced rectal cancer: Long-term analysis of 566 ypCR patients. Int J Radiat Biol Phys; 72:99-107.     
5-Ceelen WP, Van Nieuwenhove Y, Fierens K. Preoperative chemoradiation versus radiation alone for stage II and III resectable rectal cancer. Cochrane Database Syst Rev. 2009 Jan 21. CD006041
6-Douillard JY, Siena S, Cassidy J, Tabernero J, Burkes R, Barugel M. Randomized, phase III trial of panitumumab with infusional fluorouracil, leucovorin, and oxaliplatin (FOLFOX4) versus FOLFOX4 alone as first-line treatment in patients with previously untreated metastatic colorectal cancer: the PRIME study. J Clin Oncol. 2010 Nov 1. 28(31):4697-705. [Medline].          
7-Jakobsen A, Ploen J, Vuong T, Appelt A, Lindebjerg J, Rafaelsen SR. Dose-Effect Relationship in Chemoradiotherapy for Locally Advanced Rectal Cancer: A Randomized Trial Comparing Two Radiation Doses. Int J Radiat Oncol Biol Phys. 2012 May 15.
8-Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 2001 Aug 30. 345(9):638-46.           
9-Kidwell KM, Yothers G, Ganz PA, Land SR, Ko CY, Cecchini RS. Long-term neurotoxicity effects of oxaliplatin added to fluorouracil and leucovorin as adjuvant therapy for colon cancer: Results from
10-Maurer CA, Renzulli P, Kull C. The impact of the introduction of total mesorectal excision on local recurrence rate and survival in rectal cancer: long-term results. Ann Surg Oncol. 2011 Jul. 18(7):1899-906.   
11-Torre LA, Bray F, Siegel RL. Global cancer statistics, 2012. CA Cancer J Clin 2015; 65:87           
12-Wong RK, Tandan V, De Silva S, Figueredo A. Pre-operative radiotherapy and curative surgery for the management of localized rectal carcinoma. Cochrane Database Syst Rev. 2007 Apr 18. CD002102.
13-Lemmens V, Steenbergen LV, Janssenheijnen M, Martijn H, Rutten H, Coebergh JW. Trends in colorectal cancer in the south of the Netherlands 1975-2007: Rectal cancer survival levels with colon cancer survival. Acta Oncol. 2010;49:784–96. [PubMed]
14- Glimelius B, editor Multidisciplinary treatment of patients with rectal cancer. Development during the past decades and plans for the future. Mechatronics and Automation (ICMA), 2012 International Conference on; 2012. [PMC free article] [PubMed
15- Belluco C, Paoli AD, Canzonieri V, Sigon R, Fornasarig M, Buonadonna A. et al. Long-Term Outcome of Patients with Complete Pathologic Response after Neoadjuvant Chemoradiation for cT3 Rectal Cancer: Implications for Local Excision Surgical Strategies. Ann Surg Oncol. 2011;18:3686–93. [PMC free article] [PubMed]
16- Gerard JP, Francois Y, Nemoz C, Adeleine P. 55 Influence of the interval between pre-operative radiotherapy (preop-XRT) and surgery on the downstaging . 17-Skinner HD, Crane CH, Garrett CR, Eng C, Chang GJ, Skibber JM. et al. Metformin use and improved response to therapy in rectal cancer. Cancer Medicine. 2013;2:99–107. [PMC free article] [PubMed]
18-Trakarnsanga A, Ithimakin S, Weiser MR. Treatment of locally advanced rectal cancer: Controversies and questions. World J Gastroenterol. 2012;18:5521–32. [PMC free article] [PubMed].
19- Zhao HC, Gao C. Evaluation criteria of the efficacy of neoadjuvant therapy for colorectal cancer. J Digest Dis. 2011;31:253–255.
20- Boxberger F, Albrecht H, Konturek PC, Reulbach U, Maennlein G, Meyer T. et al. Neoadjuvant treatment with weekly high-dose 5-fluorouracil as a 24h-infusion, folinic acid and biweekly oxaliplatin in patients with primary resectable liver metastases of colorectal cancer: long-term results of a phase II trial. Medical Science Monitor International Medical Journal of Experimental & Clinical Research. 2010;16:19–30. [PubMed]
21- Kekelidze M, D'Errico L, Pansini M, Tyndall A, Hohmann J. Colorectal cancer:Current imaging methods and future perspectives for the diagnosis, staging and therapeutic response evaluation. World J Gastroenterol. 2013;19:8502–14. [PMC free article] [PubMed].
22-Hwang K, Park IJ, Chang SY, Lim SB, Lee JL, Yong SY, Impression of prognosis regarding pathologic stage after preoperative chemoradiotherapy in rectal cancer. World J Gastroenterology; 2015. pp. 555–62. [PMC free article] [PubMed]
23- Brændengen M, Tveit KM, Berglund Å, Birkemeyer E, Frykholm G, Påhlman L. et al. Randomized Phase III Study Comparing Preoperative Radiotherapy With Chemoradiotherapy in Nonresectable Rectal Cancer. J Clinical Oncology. 2008;26:3687–94. [PubMed]