Rectal cancer adjuvant therapy

Epidemiology and Biology of Colorectal Cancer Adjuvant Therapy of Colon Carcinoma Adjuvant Therapy of Rectal Carcinoma Future Trends in Combined Modality Therapy for Colorectal Carcinoma References... 

Adjuvant therapy differs for colon and rectal cancer because their natural history and recurrence patterns differ. Rectal cancer is more difficult to resect with wide margins, so local recurrences are more frequent than with colon cancer. Adjuvant RT plus chemotherapy is considered standard for stage 11 or 111 rectal cancer. Adjuvant chemotherapy is standard for stage 111 colon cancer and can be considered for high-risk stage II colon cancer. Adjuvant therapy is not indicated for stage I colorectal cancer because most patients are cured by surgical resection alone. 

There is currently no definitive role for adjuvant radiation in colon cancer. However, patients who receive surgery for rectal cancer receive radiation therapy to reduce local tumor recurrence. Adjuvant radiation plus chemotherapy is considered standard treatment for patients with stage II or III rectal cancer after the surgical procedure is complete.17 Preoperative radiation may be used to reduce the initial size of rectal cancers in order to make the surgical procedure easier. 

A phase I study of Xeloda in combination with XRT in rectal cancer is in the adjuvant, neoadjuvant, and palliative settings (71-73). The DLT of the combination is hand-foot syndrome and mild to moderate leukopenia, diarrhea, and local skin reaction (71-73). The recommended dose for phase 2 studies is Xeloda 825 mg/m2 twice daily without interruption in combination with standard dose of radiation. Promising activity has been demonstrated in neoadjuvant therapy with six objective responses in seven evaluable patients including one pathological confirmed CR. 

Dukes B2 and C rectal cancer GITSG No adjuvant therapy Radiation (40 14 Gy + 5-FU + semustine 35%b 55%b... 

O Connell MJ, Martenson JA, Wieand HS, et al. Improving adjuvant therapy for rectal cancer by combining protracted-infusion fluoro uracil with radiation therapy after curative surgery. N Engl J Med 1994 331 502-507. 

Chemotherapy and radiation therapy play an important role in the management of colorectal carcinoma. Significant improvements in tumor control and overall survival have been demonstrated with the use of combined-modality therapy in several randomized clinical trials performed over the past 25 yr. This chapter reviews the role of adjuvant chemotherapy and radiation therapy for colon and rectal cancer. Issues surrounding chemoradiation for rectal cancer, including sphincter preservation, total mesorectal excision, local excision, and newer chemotherapy agents, are also discussed. 

Table 4 Accepted Adjuvant Therapy Regimens for High-Risk Rectal Cancer Patients ...

Fisher B, Wolmark N, Rockette H, et al. Postoperative adjuvant chemotherapy or radiation therapy for rectal cancer results from NSABP protocol R-01. J Natl Cancer Inst 1988 80 21-29. 

NIH Consensus Conference. Adjuvant therapy for patients with colon and rectal cancer. J Am Med Assoc 1990 264 1444-1450. 

Tepper JE, O Connell MJ, Petroni GR, et al. Adjuvant postoperative fluorouracil-modulated chemotherapy combined with pelvic radiation therapy for rectal cancer initial results of Intergroup 0114. J Clin Oncol 1997 15(5) 2030-2039. 

W agman R, Minsky BD, Cohen AM, et al. Conservative management of rectal cancer with local excision and postoperative adjuvant therapy. Int J Radiat Oncol Biol Phys 1999 44 841-846. 

Tepper JE, O Connell M, Niedzwiecki D, Hollis DR, Benson AB 3rd, Cummings B, Gunderson LL, Macdonald JS, Martenson JA, Mayer RJ. Adjuvant therapy in rectal cancer analysis of stage, sex, and local control— final report of intergroup 0114. J Clin Oncol 2002 20(7) 1744-50. 

Pahlman L, Glimelius B (1995) The value of adjuvant radio(chemo)therapy for rectal cancer. Eur J Cancer 31 1347 1350... 

Ariel IM (1964) Radioactive isotopes for adjuvant cancer therapy. Arch Surg 89 244-249 Ariel IM, Padula G (1982) Treatment of asymptomatic metastatic cancer to the liver from primary colon and rectal cancer by the intraarterial administration of chemotherapy and radioactive isotopes. J Surg Oncol 20 151-156 Blanchard RJ, Grotenhuis 1, LaFave JW (1964) Treatment of experimental tumors utilization of radioactive microspheres. Arch Surg 89 406... 

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