Preoperative and Postoperative Chemotherapy for Rectal Cancer

Fig. 6.1

Protocol schema for the phase II/III Preoperative Radiation or Selective Preoperative Radiation and Evaluation Before Chemotherapy and TME (PROSPECT) trial

The role for preoperative chemotherapy is being evaluated in both Europe and China as well. The BACCHUS trial is a phase II trial that is evaluating the efficacy and toxicity of six cycles of neoadjuvant FOLFOX plus bevacizumab versus six cycles of FOLFOXIRI plus bevacizumab (NCT01650428). Chemoradiation will be selectively utilized. In addition, a three-arm phase II study is being conducted in China which will randomize patients to four cycles of neoadjuvant FOLFOX versus FOLFOX-based chemoradiation versus radiation with 5-FU alone (NCT01211210). The results of the aforementioned trials are likely to either reaffirm our current treatment paradigm or reshape the face of treatment for locally advanced rectal cancer.

References

Moertel CG, Childs DS Jr, Reitemeier RJ, Colby MY Jr, Holbrook MA. Combined 5-fluorouracil and supervoltage radiation therapy of locally unresectable gastrointestinal cancer. Lancet. 1969;2:865–7.CrossrefPubMed

Douglass HO Jr, et al. Survival after postoperative combination treatment of rectal cancer. N Engl J Med. 1986;315:1294–5.CrossrefPubMed

Krook JE, et al. Effective surgical adjuvant therapy for high-risk rectal carcinoma. N Engl J Med. 1991;324:709–15.CrossrefPubMed

Gastrointestinal Tumor Study Group. Prolongation of the disease-free interval in surgically treated rectal carcinoma. N Engl J Med. 1985;312:1465–72.Crossref

NIH consensus conference. Adjuvant therapy for patients with colon and rectal cancer. JAMA. 1990;264:1444–50.

Bosset JF, et al. Enhanced tumorocidal effect of chemotherapy with preoperative radiotherapy for rectal cancer: preliminary results–EORTC 22921. J Clin Oncol. 2005;23:5620–7.CrossrefPubMed

Bosset JF, et al. Fluorouracil-based adjuvant chemotherapy after preoperative chemoradiotherapy in rectal cancer: long-term results of the EORTC 22921 randomised study. Lancet Oncol. 2014;15:184–90.CrossrefPubMed

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;(1):CD006041.

McCarthy K, Pearson K, Fulton R, Hewitt J. Pre-operative chemoradiation for non-metastatic locally advanced rectal cancer. Cochrane Database Syst Rev. 2012;12:CD008368.PubMed

10.

De Caluwe L, Van Nieuwenhove Y, Ceelen WP. Preoperative chemoradiation versus radiation alone for stage II and III resectable rectal cancer. Cochrane Database Syst Rev. 2013;2:CD006041.

11.

Rahbari NN, et al. Neoadjuvant radiotherapy for rectal cancer: meta-analysis of randomized controlled trials. Ann Surg Oncol. 2013;20:4169–82.CrossrefPubMed

12.

Ruo L, et al. Long-term prognostic significance of extent of rectal cancer response to preoperative radiation and chemotherapy. Ann Surg. 2002;236:75–81.CrossrefPubMedPubMedCentral

13.

Quah HM, et al. Pathologic stage is most prognostic of disease-free survival in locally advanced rectal cancer patients after preoperative chemoradiation. Cancer. 2008;113:57–64.CrossrefPubMed

14.

Zorcolo L, et al. Complete pathologic response after combined modality treatment for rectal cancer and long-term survival: a meta-analysis. Ann Surg Oncol. 2012;19:2822–32.CrossrefPubMed

15.

Byfield JE, Calabro-Jones P, Klisak I, Kulhanian F. Pharmacologic requirements for obtaining sensitization of human tumor cells in vitro to combined 5-fluorouracil or ftorafur and X rays. Int J Radiat Oncol Biol Phys. 1982;8:1923–33.CrossrefPubMed

16.

O’Connell MJ, et al. Improving adjuvant therapy for rectal cancer by combining protracted-infusion fluorouracil with radiation therapy after curative surgery. N Engl J Med. 1994;331:502–7.CrossrefPubMed

17.

Smalley SR, et al. Phase III trial of fluorouracil-based chemotherapy regimens plus radiotherapy in postoperative adjuvant rectal cancer: GI INT 0144. J Clin Oncol. 2006;24:3542–7.CrossrefPubMed

18.

Schuller J, et al. Preferential activation of capecitabine in tumor following oral administration to colorectal cancer patients. Cancer Chemother Pharmacol. 2000;45:291–7.CrossrefPubMed

Only gold members can continue reading. Log In or Register to continue