Multidisciplinary management of resectable rectal cancer: New developments and controversies Journal Article
| Authors: | Minsky, B. D.; Guillem, J. G. |
| Article Title: | Multidisciplinary management of resectable rectal cancer: New developments and controversies |
| Abstract: | Until 2004, initial surgery and, in cases of pT3 and/or node-positive disease, postoperative chemoradiotherapy (radiation plus concurrent chemotherapy) was the conventional approach for patients with clinical T3 and/or node-positive rectal cancer. The German CAO/ARO/AIO 94 trial confirmed that, compared with preoperative chemoradiotherapy, postoperative chemoradiotherapy is associated with significantly higher local failure and toxicity rates as well as a decrease in the incidence of sphincter preservation. These data resulted in a change from postoperative to preoperative chemoradiotherapy. This shift to preoperative therapy has prompted a series of new questions regarding the multi-disciplinary management of rectal cancer, including: What is the ideal neoadjuvant approach (short-course vs combined-modality therapy)? Is postoperative adjuvant chemotherapy necessary for all patients following preoperative chemoradiotherapy? Do patients with node-negative rectal cancer require pelvic radiation? What is the ideal combined-modality regimen? Does an increase in response rate translate into improved local control and survival? And lastly, what is the benefit of novel radiation sensitization and delivery techniques? This review will address these and other questions surrounding the multidisciplinary management of rectal cancer. |
| Keywords: | cancer survival; treatment response; cancer surgery; clinical trial; review; cancer recurrence; bevacizumab; fluorouracil; drug withdrawal; multimodality cancer therapy; capecitabine; adjuvant therapy; cancer adjuvant therapy; cancer radiotherapy; postoperative care; chemotherapy, adjuvant; neoadjuvant therapy; radiotherapy, adjuvant; cancer staging; nuclear magnetic resonance imaging; positron emission tomography; lymph node metastasis; neoplasm staging; treatment indication; computer assisted tomography; multiple cycle treatment; blood toxicity; antineoplastic combined chemotherapy protocols; continuous infusion; radiation injury; cetuximab; irinotecan; colorectal neoplasms; survival time; patient care team; radiation dose fractionation; folinic acid; fluorodeoxyglucose f 18; gefitinib; remission induction; radiation-protective agents; interdisciplinary communication; intermethod comparison; dose fractionation; drug substitution; oxaliplatin; rectum cancer; radiation-sensitizing agents; amifostine; rectum surgery; tissue preservation; anal canal; anus sphincter; sucralfate; short course therapy; raltitrexed; 5 chloro 2,4 dihydroxypyridine plus oxonate potassium plus tegafur; uft; preoperative radiotherapy; proctitis; olsalazine |
| Journal Title: | Oncology (Norwalk) |
| Volume: | 22 |
| Issue: | 12 |
| ISSN: | 0890-9091 |
| Publisher: | C M P Medica LLC * The Oncology Group |
| Date Published: | 2008-11-15 |
| Start Page: | 1430 |
| End Page: | 1437 |
| Language: | English |
| PUBMED: | 19086601 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 5" - "Export Date: 17 November 2011" - "CODEN: OCLGE" - "Source: Scopus" |
