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Preoperative versusPostoperativeChemoradiotherapy forRectal Cancer Rolf SauerHeinz BeckerWerner Hohenberger2004 год

Preoperative versus Postoperative Chemoradiotherapy for Rectal Cancer
статья из журнала

Полный текстСтраница публикацииПубликация в OpenAlex
Аннотация: Postoperative chemoradiotherapy is the recommended standard therapy for patients with locally advanced rectal cancer. In recent years, encouraging results with preoperative radiotherapy have been reported. We compared preoperative chemoradiotherapy with postoperative chemoradiotherapy for locally advanced rectal cancer.We randomly assigned patients with clinical stage T3 or T4 or node-positive disease to receive either preoperative or postoperative chemoradiotherapy. The preoperative treatment consisted of 5040 cGy delivered in fractions of 180 cGy per day, five days per week, and fluorouracil, given in a 120-hour continuous intravenous infusion at a dose of 1000 mg per square meter of body-surface area per day during the first and fifth weeks of radiotherapy. Surgery was performed six weeks after the completion of chemoradiotherapy. One month after surgery, four five-day cycles of fluorouracil (500 mg per square meter per day) were given. Chemoradiotherapy was identical in the postoperative-treatment group, except for the delivery of a boost of 540 cGy. The primary end point was overall survival.Four hundred twenty-one patients were randomly assigned to receive preoperative chemoradiotherapy and 402 patients to receive postoperative chemoradiotherapy. The overall five-year survival rates were 76 percent and 74 percent, respectively (P=0.80). The five-year cumulative incidence of local relapse was 6 percent for patients assigned to preoperative chemoradiotherapy and 13 percent in the postoperative-treatment group (P=0.006). Grade 3 or 4 acute toxic effects occurred in 27 percent of the patients in the preoperative-treatment group, as compared with 40 percent of the patients in the postoperative-treatment group (P=0.001); the corresponding rates of long-term toxic effects were 14 percent and 24 percent, respectively (P=0.01).Preoperative chemoradiotherapy, as compared with postoperative chemoradiotherapy, improved local control and was associated with reduced toxicity but did not improve overall survival.
Год издания: 2004
Авторы: Rolf Sauer, Heinz Becker, Werner Hohenberger, Claus Rödel, Christian Wittekind, Rainer Fietkau, Peter Martus, Jörg Tschmelitsch, E. Hager, Clemens F. Hess, Johann-H. Karstens, Torsten Liersch, Heinz Schmidberger, R. Raab
Издательство: Massachusetts Medical Society
Источник: New England Journal of Medicine
Ключевые слова: Colorectal Cancer Surgical Treatments, Colorectal and Anal Carcinomas, Gastric Cancer Management and Outcomes
Другие ссылки: New England Journal of Medicine (PDF)
New England Journal of Medicine (HTML)
PubMed (HTML)