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COLLECTIVE REVIEW NO\'EA.IBLI< 75, LOI 3 - Short-course Radiation Versus Long-Course Chemoradiation for Rectal Cancer nislGf~i~nl~ld~~t5~n~iodfiaunis~7cdi~~uuzt~~6i~~ms-rG 2 i~ildildwuwfna7u iio nisa7u bba~szuz$u btazni3aiu~ ~ a ~ i a u f u tnZGiGmszuzu7a ~q~~~+i~nn~na~qnisa7ut~acl~szuz$u ~bazn7~a~u~~a~<a~n"u~niGiGms~~zu7aozbn~ n"fd ~a~~~uaun?~n"fl~zuztaa1szwi~~n~sau~t~~t~azniswiGmatmn6i~n"u Imui?aIdnis;idw~~a9 nzuz$u ~n1ei?ufqi$qwun 25 ~y ( 5 ~y 5 n k ) aazdicdimnko7nh I airn7dIuuaztin7smu w a t uaahufusniGiGmszuzuia oz1ei%tsaan.~wum 50.4 Gy (1.8 Gy 28 nR) i~ufuniskKu~nr4 6m.h uazciicdimwko7n$u 4-8 Cdm~d dsn~wiuaasszuz$u~nl~uinlu~bsdnau~~~euaz dsztnnnijua~muRaus?u ~~uaz$nim~us~a~~aun"u~~GGi~~szu~uia~n~~~u ~iqelszt~dun?elqIsd ~~a~~innisaiu~~as%u~z~S~i~lGms~i.~i~$i~m~~a~o~ninaiuwpaw~udl~~p nsztw7zi~aaiaz nszcn n'saii.ilGbi?in l u g 2001 The Colorectal Cancer Collaborative Group kmi-in'nw7uuu systematic analysis lu@ilaui~uau 8507 nu oin 22 n'nwii?ttua~aq<ufq3 %duuz~i~iildns;l ar~ii~~%~i?l~6aun7sdicdim >30 Gy amna~u~~u~~un~sn~iy~ haw~zdaazmst3u.3in~~nuzt~~a"7lGns~ ~~az~lqd~~nis~~u~~~~fi~unis~~cdi ~Au6'msimssanS?m Tnubaw7zIu@audiina7~~b~~q~q$~~7~~d~au hunisa~u~~aqdaunm t i~Gmlw~z~zaui7~z3dszGnSniw ~~uu~g/iifusz~~~~i~ $qzinu~an'uni=i~nwi retrospective aaa Fortier rraznruziauziii7auim$~8 50 Gy dau u nd d d local control uinni~ 40 Gy uaziY~in7sn'nm phase 11 du7da~uauudaaauins~an~wuupd iasamnisngu~~udi B d d Z 2 fi7sAnwi%wQmnua2iaqn"un7s~iu~~aqsz~z$u lunis6nm7u@d?ub5us%uzbaai 5 9 \unlsn'nwi The Swedish Rectal Cancer Trial ~nuau%d$au$a$uszuz cT1-3 <luau I I 68 nu ulj~~~uniju?un~sa~u~~a~szuz$ufiauni~~iiGm~tazniju~d~Kmaei~~~~ua n7sinw~iadt~amali' biiufi^~nisbiunis5anZim (overall 5-year survival 58% VS 48%. P=.004) uaz~nsinisnt?ut~u $~tawizi (I 1 % VS 27%. P<.001) aaan?saiu~~a~~~~un1~~7~~ ~O~~~?ELL~T~G~U$ i7Iiitndauniu7n$u incontinence urgency ~az~?ug~~11sznszd?mns:dsau LL~~'~U'FIR~N~~W Sin lluna7lnij~Fijwnir iinisn'nw7aa-r the ~ u t c h group (CKVO) 95-04,Ai7nis~ownfiu~fi~u d' t udGn7;lni TME (total rnesordcta~ excision) LC-IU~~~M~~H aanaaaan~sAnwid~at~am~"1G~Gu5a PAGE I
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Page 1: Short-course Radiation Versus Long-Course Chemoradiation ...medinfo2.psu.ac.th/surgery/Collective review/2556... · with T3 rectal cancer receiving short course versus long course

COLLECTIVE REVIEW NO\'EA.IBLI< 75, L O I 3 p~~ -

Short-course Radiation Versus Long-Course Chemoradiation for

Rectal Cancer

nislGf~i~nl~ld~~t5~n~iodfiaunis~7cdi~~uuzt~~6i~~ms-rG 2 i~ildildwuwfna7u i io nisa7u bba~szuz$u btazni3aiu ~ ~ a ~ i a u f u tnZGiGmszuzu7a

~q~~~+ i~nn~na~qn isa7u t~ac l~szuz$u ~ b a z n 7 ~ a ~ u ~ ~ a ~ < a ~ n " u ~ n i G i G m s ~ ~ z u 7 a o z b n ~ a u n"fd ~a~~~uaun?~n"fl~zuztaa1szwi~~n~sau~t~~t~azniswiGmatmn6i~n"u Imui?aIdnis;idw~~a9 nzuz$u ~n1ei?ufqi$qwun 25 ~y ( 5 ~y 5 nk) aazdicdimnko7nh I airn7dIuuaztin7smu

w a t uaahufusniGiGmszuzuia oz1ei%tsaan.~wum 50.4 Gy (1.8 Gy 28 nR) i~ufuniskKu~nr4 6m.h uazciicdimwko7n$u 4-8 Cdm~d dsn~wiuaasszuz$u~nl~uinlu~bsdnau~~~euaz dsztnnnijua~muRaus?u ~ ~ u a z $ n i m ~ u s ~ a ~ ~ a u n " u ~ ~ G G i ~ ~ s z u ~ u i a ~ n ~ ~ ~ u a w ? ~ a ~ ~ ~ 5 n i t ~ ~ ~ ~iqelszt~dun?elqIsd

~~a~~innisaiu~~as%u~z~S~i~lGms~i.~i~$i~m~~a~o~ninaiuwpaw~udl~~piin"olaaa nsztw7zi~aaiaz nszcn n'saii.ilGbi?in lug 2001 The Colorectal Cancer Collaborative Group kmi-in'nw7uuu systematic analysis lu@ilaui~uau 8507 nu oin 22 n'nwii?ttua~aq<ufq3 %duuz~ i~ i i l dns ; l a r ~ i i ~ ~ % ~ i ? l ~ 6 a u n 7 s d i c d i m >30 Gy a m n a ~ u ~ ~ u ~ ~ u n ~ s n ~ i y ~ ~ u haw~zdaazmst3u.3 in~~nuzt~~a"7lGns~ ~ ~ a z ~ l q d ~ ~ n i s ~ ~ u ~ ~ ~ ~ f i ~ u n i s ~ ~ c d i ~ ~ ~ ~ ~ ~ z i i ~ ~ l . L i ~Au6'msimssanS?m T n u b a w 7 z I u @ a u d i i n a 7 ~ ~ b ~ ~ q ~ q $ ~ ~ 7 ~ ~ d ~ a u hunisa~u~~aqdaunm

t i~Gmlw~z~zaui7~z3dszGnSniw ~ ~ u u ~ g / i i f u s z ~ ~ ~ ~ i ~

$qzinu~an'uni=i~nwi retrospective aaa Fortier rraznruziauziii7auim$~8 50 Gy dau u nd d d

local control u i n n i ~ 40 Gy uaziY~in7sn'nm phase 1 1 du7da~uauudaaauins~an~wuupd iasamnisngu~~udi

B d d Z 2 fi7sAnwi%wQmnua2iaqn"un7s~iu~~aqsz~z$u lunis6nm7u@d?ub5us%uzbaai 5 9 \unlsn'nwi The Swedish Rectal Cancer Trial ~nuau%d$au$a$uszuz cT1-3 <luau I I 68

nu ulj~~~uniju?un~sa~u~~a~szuz$ufiauni~~iiGm~tazniju~d~Kmaei~~~~ua n7sinw~iadt~amali' biiufi^~nisbiunis5anZim (overall 5-year survival 58% VS 48%. P=.004) uaz~nsinisnt?ut~u $~tawizi (I 1 % VS 27%. P<.001) a a a n ? s a i u ~ ~ a ~ ~ ~ ~ u n 1 ~ ~ 7 ~ ~ ~ O ~ ~ ~ ? E L L ~ T ~ G ~ U $ W U Z ~ i7Iiitndauniu7n$u incontinence urgency ~az~?ug~~11sznszd?mns:dsau L L ~ ~ ' ~ U ' F I R ~ N ~ ~ W Sin lluna7lnij~Fijwnir iinisn'nw7aa-r the ~ u t c h group (CKVO) 9 5 - 0 4 , A i 7 n i s ~ o w n f i u ~ f i ~ u

d' t udGn7;lni TME (total rnesordcta~ excision) L C - I U ~ ~ ~ M ~ ~ H aanaaaan~sAnwid~at~am~"1G~Gu5a

PAGE I

Page 2: Short-course Radiation Versus Long-Course Chemoradiation ...medinfo2.psu.ac.th/surgery/Collective review/2556... · with T3 rectal cancer receiving short course versus long course
Page 3: Short-course Radiation Versus Long-Course Chemoradiation ...medinfo2.psu.ac.th/surgery/Collective review/2556... · with T3 rectal cancer receiving short course versus long course

niswi6m b.iSnisni7aEs central radiation ~ a ~ b ~ ~ i n i s a i u a ~ a s i ~ u ~ ~ ~ ~ t ~ i ~ i s J " m ~ : ~ : s ~ a o ~ a ~ ifi'm%iassn75~mailu~Ojwum (positive radial margin) GEI 4%vs13%, P=.017 aadajamnisnfh ~ ~ u h ~ a w i z ~ n 5 s & s i n ~ s ~ ~ m ~ 4 , m % u 4 0Iuuolzdnisir7uua;ls:u-$udnun7sei7~m~$una3~~ at.nan a~azamn'ild4?ulG~a~idau lun is inwis-s -a iu~d?uu ~ ~ u ~ l n 7 s ~ i u a a a ~ s ~ u z ~ p d d o p d ~ ~ ~ ~ n'uniswi6msli1a~~ua~ugnl]au cT1-3Nx ~ u a n : ~ n i ~ ~ n w i a o ~ n i s ~ i u b b a ~ i a u ~ ~ u i b n i ~ ~ " i ~ ~ iiniiledaawqznF;Iuidauszuz cT3 a a z / w ~ a i n 1 ~ n s z o 1 u I ~ i i o ~ ~ ~ 7 a n ~ o 9 n i s ~ n l ~ i m q TROG

'4 Ej

(the Trans-Tasman Radiation Oncology Group) %.~allunis~nw7,7uum@ ~ ? % u ~ a ~ u a i a ~ i l $ u u 1ffsunis~au~ul~n~aw7zia3uaaa7uipd 3 0 5 ~ n i ~ a n ~ s a ~ u u a ~ s z u z ~ u n " ~ l n i ~ ~ i u ~ ~ a a < a ~ ~ l ~ u ~ aniju'~u'nIucjilaus-u:: cT~N., adenocarcinoma dciiluuzd~adaau 213 $19Eiiq Tmu~i~i l?u~Y~ aorrn~uoz~6?uamiiu'iGm~ajni;-w1~muiu 6 bRou nisa~u~~aa<~u9GuianS~~Gmamrim57nlsn ~ i u ~ 9 u h a . r 30/ . lunai 3 '1 (4.4%vs7.5%) LLazam 2 % l u 5 9(5.7%vs7.5%) ~ 1 i i l i S C u i 7 6 ~ n7aai%i~ay ~~azIiii~aiu~~mnii~lpd&o~ni~mau~~~n~~n~z'i)iuf3m ~ j~ lmn~so~5amImusau LLB-

fidusruzu7-a odn75~nw?6~$~6~u~o~ iu?u$auu 'eu (n=326) &r i iu?~ui i l in power=80% aaaz~m57ni5nSu~3udiIun7s~iu~aa~~~~11~8u I 5% a~~zni~~iua~aa<a~lS/iui~mGEI"i4J"m 5% $9

arnnn'wniru7n a a z n ~ s ~ n w ~ & T d 4 ~ ~ i i j n a i u ~ ~ n n i i a ~ ~ a d O j i j n a i ~ ~ ~ m n ~ i ~ ~ ~ i ~ Q ~ ~ ~ n ~ ~ n d 1 4 w 'i)ddn7sir7uuati?ulS/iu7~e\iE1"iGm $a7~~aiill?ilGe\~~~~~mnei79a~eiI~~pdudi~q~7~afifi L $ ~ ~ G L B u

d s z ~ ~ p d " a i n ~ ? o ~ s m " b u n ~ ~ ~ n w 1 6 ~ s ~ z u ~ ~ a ~ ~ n i ~ ~ m ~ i ~ ~ lmu rnedian=5.9 9 abm~unaia~b?l~~%~ nqsn~uaQu$7o7'i)bfin~$a~?n$u Cdigoz~?h~Yb6o7n~la~~op the Dutch trial ~ w u < i g m % i n 7 s n ~ u ~ ~ u &aiuguo7n 3% %u 3.5 gbgu 6% %u 6 9 b"d~dbz~an"u the German trial dwu57~ms-1n3sn~u a?tu$i~Gu&rain 5% l u 5 3a3u 7% Ipd I o 9

n k ~ l i n ~ n i s i n w ~ ~ o o n ~ ~ i w " i ~ G n i ~ ~ i ~ ~ a ~ ~ s z u z ~ u ~ 6 ~ n w " ~ u i ~ ~ i n d u $q7drisu~Ci& W L T ~ ~ O U N ~ ~ o a ~ l 7 f i a i ~ 7 5 n ~ i i ~ ~ ~ m ' b 6 p d y o u ~iaiu~~nIG~n"4~aniju'iGm16 ~~a-~iimnia::

2 a ~a~lsn.Liouil7nnisej7Km~inau w~aiui3a~~nia9eiEi79 ~ o n 7 ~ ~ ~ u s z u z ~ a a ~ 5 t . w - d i ~ n i ~ ~ i u a ~ ~ a b ~ a z msw76n & ~ ~ n ~ s f i n w i Stockholm Ill trial ~nmaou~$os6$hk 1 E9 4 c 9 8 i?dmiG wu< i "L j~ af iuyp~~azanf iwaa

o ~ ~ ~ Y b ~ f i m ~ 8 ~ ~ ~ 1 ~ 6 i n ~ ~ ~ i u ~ ~ a ~ s ~ u ~ ~ u ~ i l G ~ 6 m ~ l i ~ ~ ~ ~ ~ ~ n d ~ u I ~ ~ ~ u ~ ~ ~ ~ ~ u n - 6 1

1.9%vs28%, P<.001 I p d the Australian study LIR: 3%vs18%, P<.001 l u the Polish trial) sau Idn' .r i ic4~~di ior iouni7 ~ n u i z ~ u @ a u ~ i u % ~ ~ ~ ~ a b ~ u q w o o z ? u u ~ b n ~ e r ' ~ s ~ " m ~ ~ a B z G a 6 a a a i Z u

d 5EHZL3R7MOz necrosis M$~~IT~JI~LLR~

CLh 5;

l u u ~ z C ; n ~ s a i u a a a ~ ~ ~ ~ ~ u ~ A u q C i ; i n ~ ~ d a ~ u a w ~ ~ u u a u n l u ~ ~ e u ~ n n ~ s ~ n w ~ ~aa:qaG;l 33%lu the UppsaIa study u s n o ~ n ~ u j r i a i u i s n I S / i i a ~ ~ n " u ~ n i ~ ~ ' i ~ m a a : I i d u n ~ ~ ~ f i u ~ w ~ y2mna~mui i l 6

n is inwiaos Bujiko aaazqnz~am9%Ga~u~9q~~n73&%~9 CRM +(circumferential radial d d

margin) namapauesiuaa~~zuzu~a<a~n"u~~iiu'~Gm~ffuun"u~zuz~u (4% vs 13%. P=.017) ~ $ 9

sende~iiuniqq9(q~~~inn<710.1 GEII I cm ~ i n ~ ~ m i l n ~ i ~ ~ ~ ~ ~ n ) i9ii '~ni~&ni5n%u dpd$ipdyou n i id ionr i~$ i l@naidn5od i l n ~ n ~ s a i u n a i s t . u z ~ ~ d l O j Y b 6 a m ~ C ~ n ~ d n ~ ~ ~ b u ~ u n ~ i ~ n u ~ bnzi-6 n ? ~ ~ ~ u ~ b a a w ~ ~ n i s w i ~ m ~ $ i l ~ ~ n " m w ~ n CRM +

Page 4: Short-course Radiation Versus Long-Course Chemoradiation ...medinfo2.psu.ac.th/surgery/Collective review/2556... · with T3 rectal cancer receiving short course versus long course

- ~ i a z ~ ~ ~ ~ n d a o d 1 u ~ : ~ z k p d ~ d ~ ~ u n a ' i (1.9%vs28%, ~<.001%u the Austra- lian study bbaz 3%vs18%, P<.001 %u the Polish trial) - i i%d4iuJa~n-h - a~nann41 - ~wuizn 'u@au~ iada~r~a i iuqwaoz ?uul1R~LilGa

- qf l6n156~~9 CRM +(circumferential

radial margin) iianas (4% vs 13%, P=.017)

- ~~aua%PdY~~iloe3 5-year survival

~ i n n a ' i - tAuyznnaisnGnl6u7nn-6~

a, d - ~ d u ~ ~ ~ n i s & ~ ~ w a n ~ ~ ~ ~ l ~ ~ u n % o d ~ ~ o u ?nnisinwi ~oazqafh 33%lu the Uppsala study

- 1~u~en7 i l du second malignancy - sunau bowel movement ;uinn<? - ST~nia~fiw erectile dysfunction

u~nn41 - I~a?uisn%G<aun"urniEI"7Ge\ - I r i~duni~r i iusi7w1~~nwai~w~nl6 - I r i " l a n i f 7 n ? ~ ~ n ~ d n g u ~ Q u d ~ I u ~ G ~ q a n $nidi~rwrjacjanii 10 cm ~7sd -1 n415 Crn

- bi~~?%.ii. j lu~infl3?

- l6?uniss'nwi~uinr5uld ( I 8% %u t h e German study)

1. Minsky BD. Short-course radiation versus long-course chemoradiation for rectal cancer: making progress. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 201 2;30(31):3777-8.

2. Colorectal Cancer Collaborative Group: Adjuvant radiotherapy for rectal cancer: a systematic overview of 8,507 patients from 22 randomised trials. Lancet 2001, 358:1291-1304. '

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3. David Sebag-Montefiore GR. Choosing between short-course preoperative radiotherapy and long-course chemoradiation therapy. Current Colorectal Cancer Reports 5(4): 232-9.

4. Improved survival with preoperative radiotherapy in resectable rectal cancer. Swedish Rectal Cancer Trial. The New England journal of medicine. 1997;336(14):980-7

5. Sauer R, Fietkau R, Wittekind C, Rodel C, Martus P, Hohenberger W, et al. Adjuvant vs. neoadjuvant radiochemotherapy for locally advanced rectal cancer: the German trial CAO/ARO/AIO-94. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2003;5(5):406-15.

6. Bujko K, Bujko M. Point: short-course radiation therapy is preferable in the neoadjuvant treatment of rectal cancer. Seminars in radiation oncology. 201 1 ;21(3): 220-7.

7. Minsky BD. Counterpoint: long-course chemoradiation is preferable in the neoadjuvant treatment of rectal cancer. Seminars in radiation oncology. 201 1 ;21(3): 228-33.

8. Mohiuddin M, Marks J, Marks G. Management of rectal cancer: short- vs. long- course preoperative radiation. International journal of radiation oncology, biology, physics: 2008;72(3):636-43.

9. Tiefenbacher U, Wenz F. [Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer]. Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft [et all. 2001 ;177(12):682-4.

10.Chan AK, Wong AO, Langevin J, et al. Preoperative chemoradiotherapy and pelvic radiation for tethered or fixedrectal cancer: a phase II dose escalation study. Int J Ra- diat Oncol Biol Phys 2000; 48 (3): 843-56.

11 .Ahmad NR, Marks G, Mohiuddin M. High-dose pre-operative radiation for cancer of the rectum: impact ofradiation dose on patterns of failure and survival. lntJ Radiat Oncol Biol Phys 1993; 27: 773-8.

12.Mohiuddin M, Winter K, Mitchell E, et al. Randomizedphase II study of neoadjuvant combined-modality chemoradiation for distal rectal cancer: Radiation TherapyOncology Group Trial 0012. J Clin Oncol 2006; 24 (4):650-5.

13.Fortier GA, Constable WC, Meyers H, et al. Preoperativeradiation therapy for rectal cancer. Arch Surg 1 986; 121 : I 380-4.

14.Peeters KC, van de Velde CJ, Leer JW, et al.: Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: increased bowel dysfunction in irradiated patients-a Dutch colorectal cancer group study. J Clin Oncol 2005, 23:6199-6206.

15.Marijnen CA, van de Velde CJ, Putter H, et al.: Impact of short-term preoperative radiotherapy on health-related quality of life and sexual functioning in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol 2005,23:1847-1858.

16.Marijnen CA, Kapiteijn E, van de Velde CJ, et al.: Acute side effects and complications after short-term preoperative radiotherapy combined with total * ,

mesorectal excision in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol 2002, 20:817-825.

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17.McLachlan S, Fisher R, McLure B, et al.: A comparison of quality of life in patients with T3 rectal cancer receiving short course versus long course radiation. A Trans- Tasman Radiation Oncology Group Trial (TROG 01.04) [abstract]. J Clin Oncol 2008, 26:4097.

18.Siegel R, Burock S, Wernecke KD, et al.: Preoperative short- course radiotherapy versus combined radiochemotherapy in locally advanced rectal cancer: a multi-centre prospectively randomised study of the Berlin Cancer Society. BMC Cancer 2009, 9:50.

19.Nilsson PJ, van Etten B, Hospers GA, Pahlman L, van de Velde CJ, Beets-Tan RG, et al. Short-course radiotherapy followed by neo-adjuvant chemotherapy in locally advanced rectal cancer--the RAPID0 trial. BMC cancer. 201 3;13:279.