Surgery
Volume 145, Issue 5 , Pages 486-494 , May 2009

Outcomes of clinical T4M0 extra-peritoneal rectal cancer treated with preoperative radiochemotherapy and surgery: A prospective evaluation of a single institutional experience

  • Vincenzo Valentini, MD

      Affiliations

    • Department of Radiation Therapy, Università Cattolica del Sacro Cuore, Rome, Italy
    • ,
  • Claudio Coco, MD, FACS

      Affiliations

    • Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
    • Corresponding Author InformationReprint requests: Claudio Coco, Università Cattolica del Sacro Cuore, Policlinico “A. Gemelli,” Largo A. Gemelli 8, 00168 – Rome, Italy.
    • ,
  • Gianluca Rizzo, MD

      Affiliations

    • Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
    • ,
  • Alberto Manno, MD

      Affiliations

    • Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
    • ,
  • Antonio Crucitti, MD

      Affiliations

    • Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
    • ,
  • Claudio Mattana, MD

      Affiliations

    • Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
    • ,
  • Carlo Ratto, MD

      Affiliations

    • Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
    • ,
  • Alessandro Verbo, MD

      Affiliations

    • Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
    • ,
  • Fabio M. Vecchio, MD

      Affiliations

    • Department of Histopathology, Università Cattolica del Sacro Cuore, Rome, Italy
    • ,
  • Brunella Barbaro, MD

      Affiliations

    • Department of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy
    • ,
  • Maria A. Gambacorta, MD

      Affiliations

    • Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
    • Department of Radiation Therapy, Università Cattolica del Sacro Cuore, Rome, Italy
    • ,
  • Caterina Montoro, MD

      Affiliations

    • Department of Radiation Therapy, Università Cattolica del Sacro Cuore, Rome, Italy
    • ,
  • Maria C. Barba, MD

      Affiliations

    • Department of Radiation Therapy, Università Cattolica del Sacro Cuore, Rome, Italy
    • ,
  • Luigi Sofo, MD

      Affiliations

    • Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
    • ,
  • Valerio Papa, MD

      Affiliations

    • Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
    • ,
  • Roberta Menghi, MD

      Affiliations

    • Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
    • ,
  • Domenico M. D'Ugo, MD, FACS

      Affiliations

    • Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
    • ,
  • Giovanbattista Doglietto, MD

      Affiliations

    • Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy

,Accepted 23 January 2009.

References 

  1. Pearlman NW, Stiegmann GV, Donohue RE. Extended resection of fixed rectal cancer. Cancer. 1989;63:2438–2441
  2. Heslov SF, Frost DB. Extended resection for primary colorectal carcinoma involving adjacent organs or structures. Cancer. 1988;62:1637–1640
  3. Fleming ID, Cooper JS, Henson DE, et al. AJCC Cancer Staging Handbook. Phialdelphia: Lippincott-Raven; 1998;p. 10
  4. Farouk R, Nelson H, Gunderson LL. Aggressive multimodality treatment for locally advanced irresectable rectal cancer. Br J Surg. 1997;84:741–749
  5. Meterissian SH, Skibber JM, Giacco GG, et al. Pelvic exenteration for locally advanced rectal carcinoma: factors predicting improved survival. Surgery. 1997;121:479–487
  6. Chen ET, Mohiuddin M, Brodovsky H, et al. Downstaging of advanced rectal cancer following combined preoperative chemotherapy and high dose radiation. Int J Radiat Biol Phys. 1994;30:169–175
  7. Movsas B, Hanlon AL, Lanciano R, et al. Phase I dose escalating trial of hyperfractionated pre-operative chemoradiation for locally advanced rectal cancer. Int J Radiat Biol Phys. 1998;42:43–50
  8. Carraro S, Roca EL, Cartelli C, et al. Radiochemotheapy with short daily infusion of low-dose oxaliplatin, leucovorin, and 5-FU in T3-T4 unresectable rectal cancer: a phase II IATTGI study. Int J Radiat Biol Phys. 2002;54:397–402
  9. De la Torre A, Ramos S, Valcarcel FJ, et al. Phase II study of radiochemotherapy with UFT and low-dose oral leucovorin in patients with unresectable rectal cancer. Int J Radiat Biol Phys. 1999;45:629–634
  10. Myerson RJ, Valentini V, Birnbaum EH, et al. A phase I/II trial of three-dimensionally planned concurrent boost radiotherapy and protracted venous infusion of 5-FU chemotherapy for locally advanced rectal carcinoma. Int J Radiat Biol Phys. 2001;50:1299–1308
  11. Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncology Biol Phys. 1995;31:1341–1346
  12. Miller AB. Reporting result of cancer treatment. Cancer. 1981;47:207–214
  13. Valentini V, Coco C, Cellini N, et al. Ten years of preoperative chemoradiation for extraperitoneal T3 rectal cancer: acute toxicity, tumor response, sphincter preservation in three consecutive studies. Int J Radiat Oncol Biol Phys. 2001;51:371–383
  14. Sobin LH, Wittekind C. TNM Classification of malignant tumours. 6th ed. New York: Wiley-Liss; 2002;
  15. Machover D, Goldschmidt E, Challet P, et al. Treatment of advanced colorectal and gastric carcinoma with 5-fluorouracil and high-dose folinic acid. J Clin Oncol. 1986;4:685–696
  16. de Gramont A, Louvet C, Andre T, Tournigand C, Krulik M. A review of GERCOD trials of bimonthly leucovorin plus 5-fluorouracil 48-h continuous infusion in advanced colorectal cancer: evolution of a regimen. Groupe d'Etude et de Recherche sur les Cancers de l'Ovaire et Digestifs (GERCOD). Eur J Cancer. 1998;34:619–626
  17. Minsky BD, Cohen AM, Enker WE, et al. Radiation therapy for unresectable rectal cancer. Int J Radiat Oncol Biol Phys. 1991;21:1283–1289
  18. Minsky BD, Cohen AM, Enker WE, et al. Preoperative 5-FU, low dose leucovorin and radiation therapy for locally advanced and unresectable rectal cancer. Int J Radiat Oncol Biol Phys. 1997;37:289–295
  19. Mohiuddin M, Regine WF, John WJ, et al. Preoperative chemoradiation in fixed distal rectal cancer: dose time factors for pathological complete response. Int J Radiat Oncol Biol Phys. 2000;46:883–888
  20. Videtic GM, Fisher BJ, Perera FE, et al. Preoperative radiation with concurrent 5-fluorouracil continuous infusion for locally advanced unresectable rectal cancer. Int J Radiat Oncol Biol Phys. 1998;42:319–324
  21. Chan A, Wong A, Langevin J, et al. Preoperative concurrent 5-fluorouracil infusion, mitomicin C and pelvic radiation therapy in tethered and fixed rectal carcinoma. Int J Radiat Oncol Biol Phys. 1993;25:791–799
  22. Minsky BD, Cohen AM, Kemeny N, et al. The efficacy of preoperative 5-fluorouracil, high-dose leucovorin, and sequential radiation therapy for unresectable rectal cancer. Cancer. 1993;71:3486–3492
  23. Rich TA, Skibber JM, Ajani JA, et al. Preoperative infusional chemoradioation therapy for stage T3 rectal cancer. Int Radiat Oncol Biol Phys. 1995;32:1025–1029
  24. Chiari RS, Tyler DS, Anscher MS, et al. Preoperative radiation and chemotherapy in the treatment of adenocarcinoma of the rectum. Ann Surg. 1995;221:778–786
  25. Valentini V, Coco C, Cellini N, et al. Preopertaive chemoradiation for extraperitoneal T3 rectal cancer: acute toxicity, tumor response and sphincter preservation. Int J Radiat Oncol Biol Phys. 1998;40:1067–1075
  26. Luna-Perez P, Rodriguez-Ramirez S, Rodriguez-Coria DF, et al. Preoperative chemoradiation therapy and anal sphincter preservation with locally advanced rectal adenocarcinoma. World J Surg. 2001;25:1006–1011
  27. Grann A, Feng C, Wong D, et al. Preoperative combined modality therapy for clinically resectable UT3 rectal adenocarcinoma. Int J Radiat Oncol Biol Phys. 2001;49:987–995
  28. Rullier E, Goffre B, Bonnel C, Zerbib F, Caudry M, Sarc J. Preoperative radiochemotherapy and sphincter-saving resection for T3 carcinomas of the lower third of the rectum. Ann Surg. 2001;234:633–640
  29. Kapiteijn E, Marijnen CAM, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 2001;345:638–646
  30. Sauer R, Heinz B, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351:1731–1740
  31. Stockholm Colo-rectal Cancer Study Group . The Stockholm II trial on preoperative short term radiotherapy in operable rectal carcinoma. A prospective randomized trial. Proc Am Soc Clin Oncol. 1994;13:198
  32. Swedish Rectal Cancer Trial Group . Improved survival with preoperative radiotherapy in resectable rectal cancer. Swedish Rectal Cancer Trial. N Engl J Med. 1997;336:980–987
  33. Sanfilippo NJ, Crane CH, Skibber J, et al. T4 rectal cancer treated with preoperative chemoradiation to the posterior pelvis followed by multivisceral resection: patterns of failure and limitations of treatment. Int J Radiat Oncol Biol Phys. 2001;51:176–183
  34. Marsh RD, Chu NM, Vauthey JN, et al. Preoperative treatment of patients with locally advanced unresectable rectal adenocarcinoma utilizing continuous chronobiologically shaped 5-fluorouracil infusion and radiation therapy. Cancer. 1996;78:217–225
  35. Rodel C, Grabenbauer GG, Schick C, et al. Preoperative radiation with concurrent 5-fluorouracil for locally advanced T4-primary rectal cancer. Strahlenther Onkol. 2000;176:161–167
  36. Dosoretz DE, Gunderson LL, Hedberg S, et al. Preoperative irradiation for unresectable rectal and rectosigmoid carcinoma. Cancer. 1983;52:814–818
  37. Marsh PJ, James RD, Scholfield PF. Adjuvant preoperative radiotherapy for locally advanced rectal carcinoma. Results of a prospective randomized trial. Dis Colon Rectum. 1994;37:1205–1214
  38. Gunderson LL, Martin JK, Beart RW. Intraoperative and external beam irradiation for locally advanced colorectal cancer. Am Surg. 1988;207:52–60
  39. Willett CG, Shellito PC, Tepper JE, et al. Intraoperative electron beam radiation therapy for recurrent locally advanced rectal or rectosigmoid carcinoma. Cancer. 1991;67:1504–1508
  40. Willett CG, Shellito PC, Tepper JE, et al. Intraoperative electron beam radiation therapy for primary locally advanced rectal or rectosigmoid carcinoma. J Clin Oncol. 1991;9:843–849
  41. Mendenhall WM, Souba WW, Bland KI, et al. Preoperative irradiation and surgery for initially unresectable adenocarcinoma of the rectum. Am Surg. 1992;58:423–429
  42. Frykholm GJ, Pahlman L, Glimelius B. Combined chemo- and radiotherapy vs. radiotherapy alone in the treatment of primary, nonresectable adenocarcinoma of the rectum. Int J Radiat Oncol Biol Phys. 2001;50:427–434
  43. Moriya Y, Akasu T, Fujita S, Yamamoto S. Aggressive surgical treatment for patients with T4 rectal cancer. Colorectal Dis. 2003;5:427–431
  44. Burke S, Percapio BA, Knight DC, et al. Combined preoperative radiation and mitomycin/5-fluoruracil treatment for locally advanced rectal adenocarcinoma. J Am Coll Surg. 1998;187:164–170
  45. Yiu R, Wong SK, Cromwell J, et al. Pelvic wall involvement denotes a poor prognosis in T4 rectal cancer. Dis Colon Rectum. 2001;44:1676–1681
  46. Mohiuddin M, Marks GJ. High dose preoperative radiation and sphincter preservation in the treatment of rectal cancer. Int J Radiat Oncol Biol Phys. 1987;13:839–842
  47. Wagman R, Minsky BD, Cohen AM, et al. Sphincter preservation in rectal cancer with preoperative radiation therapy and coloanal anastomosis: long-term follow-up. Int J Radiat Oncol Biol Phys. 1998;42:51–57
  48. Janjan NA, Khoo VS, Abbruzzese J, et al. Tumor downstaging and sphincter preservation with preoperative chemoradiation in locally advanced rectal cancer: the M.D. Anderson Cancer Center experience. Int J Radiat Oncol Biol Phys. 1999;15:1027–1038
  49. Valentini V, Coco C, Cellini N, et al. Preoperative chemoradiation with cisplatin and 5-fluorouracil extraperitoneal T3 rectal cancer: acute toxicity, tumor response, sphincter preservation. Int J Radiat Oncol Biol Phys. 1999;45:1175–1184
  50. Verschueren RC, Mulder NH, Van Loon AJ, et al. The anatomical substrate for a difference in surgical approach to rectal cancer in male and female patients. Anticancer Res. 1997;17:637–641
  51. Sebag-Montefiore D, Glynne-Jones R, Falk S, et al. A phase I-II study of oxaliplatin when added to 5–Fluoruracil and Leucovorin and pelvic radiation in locally advanced rectal cancer: a Colorectal Clinical Oncology Group (CCOG) study. Br J Cancer. 2005;93:993–998
  52. Seong J, Ho-Cho J, Kim NK, et al. Preoperative chemoradiotherapy with oral doxifluridine plus low dose oral leucovorin in unresectable primary rectal cancer. Int J Radiat Oncol Biol Phys. 2001;50:435–439
  53. Glynne-Jones R, Sebag-Montefiore D, Maughan TS, et al. A phase I dose escalation study of continuous oral capecitabine in combination with oxaliplatin and pelvic radiation (Xelox – RT) in patients with locally advanced rectal cancer. Ann Oncol. 2006;17:50–56
  54. Theodoropoulos G, Wise WE, Padmanabhan A, et al. T-level downstaging and complete pathologic response after preoperative chemoradiation for advanced rectal cancer result in decreased recurrence and improved disease-free survival. Dis Colon Rectum. 2002;45:895–903
  55. Ruo L, Tickoo S, Klimstra D, et al. Long-term prognostic significance of extent of rectal cancer response to preoperative radiation and chemotherapy. Ann Surg. 2002;236:75–81
  56. Vecchio FM, Valentini V, Minsky BD, et al. The relationship of pathologic tumor regression grade (TRG) and outcomes after preoperative therapy in rectal cancer. Int J Radiat Oncol Biol Phys. 2005;62:752–760
  57. Habr-Gama A, Perez RO, Nadalin W, et al. Long-term results of preoperative chemoradiation for distal rectal cancer correlation between final stage and survival. J Gastroenterol Surg. 2005;9:90–101
  58. Coco C, Valentini V, Manno A, et al. Long-term results after neoadjuvant radiochemotherapy for locally advanced resectable extraperitoneal rectal cancer. Dis Colon Rectum. 2006;49:311–318

PII: S0039-6060(09)00067-1

doi: 10.1016/j.surg.2009.01.007

Surgery
Volume 145, Issue 5 , Pages 486-494 , May 2009

Article Tools

* Image Usage & Resolution