Short course versus Long course radiation for preoperative treatment of rectal cancer Part 1, and welcome!

Listen to the part 1 of the 2 part inaugural episode of the Surg Onc Files, where Linda and Brad dive into the morass of trials regarding the optimal preoperative radiation regimen for rectal cancer. Spoiler alert: it’s complicated! But hopefully less confusing after the episode. For part 1 of this episode gives an overview of the workup/ management for rectal cancer.


Rectal cancer workup/staging/basic treatment options 2:48

Preop therapy is better (Dutch Trial/German Trial) 10:43

Short course v Long course seems equivalent (Polish Trial/TROG01.04 Trial) 15:38


Literature Discussed/ Background Reading

NCCN Guidelines for Rectal Cancer

Updated guidelines highlighting management strategy for rectal cancer.

Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer.

Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, Rutten HJ, Pahlman L, Glimelius B, van Krieken JH, Leer JW, van de Velde CJ; Dutch Colorectal Cancer Group.

Dutch Trial: NEJM 2001, RCT comparing preoperative SC radiation with surgery alone in all resectable rectal cancer patients. Conclusion: Preop SC radiation is beneficial for decreasing local recurrence when compared to surgery alone, but the benefit is really for T3/T4 or node positive patients.

Swedish Rectal Cancer Trial: long lasting benefits from radiotherapy on survival and local recurrence rate.

Folkesson J, Birgisson H, Pahlman L, Cedermark B, Glimelius B, Gunnarsson U.

Swedish Trial: JCO 2005, RCT comparing SC preop radiation with surgery alone, also all T stages. Conclusion: SC radiation conferred both a benefit in terms of local recurrence AND overall survival–thus far the only trial to do so.

Preoperative versus postoperative chemoradiotherapy for rectal cancer.

Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, Fietkau R, Martus P, Tschmelitsch J, Hager E, Hess CF, Karstens JH, Liersch T, Schmidberger H, Raab R; German Rectal Cancer Study Group.

German Trial: NEJM 2004, RCT comparing preoperative LC chemoradiation with POSToperative LC chemoradiation in rectal cancer for T3/T4 or N+ disease. Conclusion: Preoperative LC had lower local recurrence rates compared to postop LC (6% v 13%) and also had lower toxicity and higher rates of therapy completion.

Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer.

Bujko K, Nowacki MP, Nasierowska-Guttmejer A, Michalski W, Bebenek M, Kryj M.

Polish Trial: BJS 2006, RCT comparing preoperative SC radiation vs preoperative LC chemoradiation. Conclusion: No difference in OS, DSS or local recurrence at four years. Also no difference in severe toxicities.

Randomized trial of short-course radiotherapy versus long-course chemoradiation comparing rates of local recurrence in patients with T3 rectal cancer: TransTasman Radiation Oncology Group trial 01.04.

Ngan SY, Burmeister B, Fisher RJ, Solomon M, Goldstein D, Joseph D, Ackland SP, Schache D, McClure B, McLachlan SA, McKendrick J, Leong T, Hartopeanu C, Zalcberg J, Mackay J.

TransTasman Trial (TROG 01.04): 2012 JCO, RCT comparing preoperative SC radiation with LC chemoradiation in T3 rectal cancer patients. Conclusion: At three years f/u, no difference in local recurrence, OS, DFS, distant recurrence or late toxicity.

Acute Adverse Events and Postoperative Complications in a Randomized Trial of Preoperative Short-course Radiotherapy Versus Long-course Chemoradiotherapy for T3 Adenocarcinoma of the Rectum: Trans-Tasman Radiation Oncology Group Trial (TROG 01.04).

Ansari N, Solomon MJ, Fisher RJ, Mackay J, Burmeister B, Ackland S, Heriot A, Joseph D, McLachlan SA, McClure B, Ngan SY.

Operative complications and acute adverse events from TROG 01.04 data. Conclusion: Long course patients had significantly higher rate of acute AE, while POCs were similar between arms, slightly (but not significantly) higher leak rate with SC (7% v 3.5%).

This episode was produced by Linda Jin and Brad Krasnick.
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