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Chemoradiation in Therapy for Colon and Rectum Carcinoma

  • Jason H. Lee
  • Christopher G. Willett
Part of the Cancer Drug Discovery and Development book series (CDD&D)

Abstract

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.

Keywords

Rectal Cancer Clin Oncol Total Mesorectal Excision Local Excision Radiat Oncol Biol Phys 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Greenlee RT, Murray T, Bolden S, Wingo PA. Cancer Statistics, 2000. CA Cancer J Clin 2000; 50 (1): 7–33.PubMedCrossRefGoogle Scholar
  2. 2.
    Compton CC, Fielding LP, Burgart LJ, et al. Prognostic factors in colorectal cancer. College of American Pathologists Consensus Statement 1999. Arch Pathol Lab Med 2000; 124: 979–994.PubMedGoogle Scholar
  3. 3.
    Elsaleh H, Joseph D, Grieu F, et al. Association of tumour site and sex with survival benefit from adjuvant chemotherapy in colorectal cancer. Lancet 2000; 355 (9217): 1745–1750.PubMedCrossRefGoogle Scholar
  4. 4.
    Shibata D, Reale MA, Lavin P, et al. The DCC protein and prognosis in colorectal cancer. N Engl J Med 1996; 335: 1727–1737.PubMedCrossRefGoogle Scholar
  5. 5.
    Galandiuk S, Wieand HS, Moertel CG, et al. Patterns of recurrence after curative resection of carcinoma of the colon and rectum. Surg Gyn Obst 1992; 174: 27–32.PubMedGoogle Scholar
  6. 6.
    Wolmark N, Fisher B, Rockette H, et al. Postoperative adjuvant chemotherapy or BCG for colon cancer. Results from NSABP protocol C-01. J Natl Cancer Inst 1988; 80: 30–36.PubMedCrossRefGoogle Scholar
  7. 7.
    Laurie JA, Moertel CG, Fleming TR, et al. Surgical adjuvant therapy of large bowel carcinoma: an evaluation of levamisole and the combination of levamisole and 5-fluorouracil. J Clin Oncol 1989; 7: 1447–1456.PubMedGoogle Scholar
  8. 8.
    Moertel CG, Fleming TR, Macdonald JS, et al. Fluorouracil plus levamisole as effective adjuvant therapy after resection of stage III colon carcinoma: a final report. Ann Intern Med 1995; 122: 321–326.PubMedGoogle Scholar
  9. 9.
    Wolmark N, Rockette H, Wickerham DL, et al. The benefit of leucovorin modulated fluorouracil as postoperative adjuvant therapy for primary colon cancer: results from National Surgical Adjuvant Breast and Bowel Project Protocol C-03. J Clin Oncol 1993; 11: 1879–1887.PubMedGoogle Scholar
  10. 10.
    Wolmark N, Rockette H, Mamounas EP, et al. The relative efficacy of 5-FU + leuocovorin (FU-LV), 5-FU + levamisole (FU-LEV), and 5-FU + leucovorin + levamisole (FU-LV-LEV) in patients with Dukes’ B and C carcinoma of the colon: first report of the NSABP C-04 [Abstract]. Proc Am Soc Clin Oncol 1996; 15: 205.Google Scholar
  11. 11.
    Haller DG, Catalano PJ, Macdonald JS, et al. Fluorouracil (FU), leuocovorin (LV) and levamisole (LEV) adjuvant therapy for colon cancer: five-year report of INT-0089 [Abstract]. Proc Am Soc Clin Oncol 1998; 17: 256a.Google Scholar
  12. 12.
    Moertel CG, Fleming TR, Macdonald JS, et al. Intergroup study of fluorouracil plus levamisole as adjuvant therapy for stage II/Dukes’ B2 colon cancer. J Clin Oncol 1995; 13: 2936–2943.PubMedGoogle Scholar
  13. 13.
    International Multicentre Pooled Analysis of B2 Colon Cancer Trials (IMPACT B2) Investigators. Efficacy of adjuvant fluorouracil and folinic acid in B2 colon cancer. J Clin Oncol 1999; 17: 1356–1363.Google Scholar
  14. 14.
    Mamounas E, Wieand S, Wolmark N, et al. Comparative efficacy of adjuvant chemotherapy in patients with Dukes’ B versus Dukes’ C colon cancer: results from four National Surgical Adjuvant Breast and Bowel Project adjuvant studies (C-01, C-02, C-03, and C-04). J Clin Oncol 1999; 17: 1349–1355.PubMedGoogle Scholar
  15. 15.
    Willett CG, Fung CY, Kaufman DS, Efird J, Shellito PC. Postoperative radiation therapy for high-risk colon carcinoma. J Clin Oncol 1993; 11 (6): 1112–1117.PubMedGoogle Scholar
  16. 16.
    MartensonJ, Willett C, Sargent C, et al. A phase III study of adjuvant radiation therapy (RT), 5-fluorouracil (5-FU), and levamisole (LEV) vs 5-FU and LEV in selected patients with resected, high risk colon cancer: initial results of INT 0130 [abstract]. Proc Am Soc Clin Oncol 1999; 235a.Google Scholar
  17. 17.
    Fabian C, Giri S, Estes N, et al. Adjuvant continuous infusion 5-FU, whole-abdominal radiation, and tumor bed boost in high-risk stage III colon carcinoma: a Southwest Oncology Group pilot study. Int J Radiat Oncol Biol Phys 1995; 32: 457–464.PubMedCrossRefGoogle Scholar
  18. 18.
    Allee PE, Tepper JE, Gunderson LL, Munzenrider JE. Postoperative radiation therapy for incompletely resected colorectal carcinoma. Int J Radiat Oncol Biol Phys 1989; 17: 1171–1176.PubMedCrossRefGoogle Scholar
  19. 19.
    Schild SE, Gunderson LL, Haddock MG, et al. The treatment of locally advanced colon cancer. Int J Radiat Oncol Biol Phys 1997; 37 (1): 51–58.PubMedCrossRefGoogle Scholar
  20. 20.
    Rich T, Gunderson, LL, Lew R, et al. Patterns of recurrence of rectal cancer after potentially curative surgery. Cancer 1983; 52: 1317–1329.PubMedCrossRefGoogle Scholar
  21. 21.
    Minsky BD, Mies C, Recht A, et al. Resectable adenocarcinoma of the rectosigmoid and rectum: 1. Patterns of failure and survival. Cancer 1988; 61: 1408–16.PubMedCrossRefGoogle Scholar
  22. 22.
    Tepper JE, Cohen AM, Wood WC, et al. Postoperative radiation therapy of rectal cancer. Int J Radiat Oncol Biol Phys 1987; 13: 5–10.PubMedCrossRefGoogle Scholar
  23. 23.
    Gastrointestinal Tumor Study Group. Prolongation of the disease-free interval in surgically treated rectal carcinoma. N Engl J Med 1985; 312: 1465–1472.CrossRefGoogle Scholar
  24. 24.
    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.PubMedCrossRefGoogle Scholar
  25. 25.
    NIH Consensus Conference. Adjuvant therapy for patients with colon and rectal cancer. JAm Med Assoc 1990; 264: 1444–1450.CrossRefGoogle Scholar
  26. 26.
    Krook JE, Moertel CG, Gunderson LL, et al. Effective surgical adjuvant therapy for high-risk rectal carcinoma. N Engl J Med 1991; 324: 704–715.CrossRefGoogle Scholar
  27. 27.
    Gastrointestinal Tumor Study Group. Radiation therapy and fluorouracil with or without semustine for the treatment of patients with surgical adjuvant adenocarcinoma of the rectum. J Clin Oncol 1992; 10: 549–557.Google Scholar
  28. 28.
    O’Connell MJ, Martenson JA, Wieand HS, et al. Improving adjuvant therapy for rectal cancer by combining protracted-infusion fluorouracil with radiation therapy after curative surgery. N Engl J Med 1994; 331: 502–507.PubMedCrossRefGoogle Scholar
  29. 29.
    Wolmark N, Wieand HS, Hyams DM, et al. Randomized trial of postoperative adjuvant chemotherapy with or without radiotherapy for carcinoma of the rectum: National Surgical Adjuvant Breast and Bowel Project Protocol R-02. J Natl Cancer Inst 2000; 92 (5): 388–396.PubMedCrossRefGoogle Scholar
  30. 30.
    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.PubMedGoogle Scholar
  31. 31.
    Siani A, Cunningham D, Norman AR et al. Multicentre randomized trial of protracted venous infusion (PVI) 5 FU compared to 5 FU/folinic acid (5FU/FA) as adjuvant therapy for colorectal cancer [Abstract]. Proc Am Soc Clin Oncol 2000; 19: 240a.Google Scholar
  32. 32.
    Paty PB, Enker WE, Cohen AM, et al. Long-term functional results of coloanal anastomosis for rectal cancer. Am J Surg 1994; 167: 90–95.PubMedCrossRefGoogle Scholar
  33. 33.
    MacFarlane JK, Ryall RD, Heald RJ. Mesorectal excision for rectal cancer. Lancet 1993 Feb 20; 341 (8843): 457–460.CrossRefGoogle Scholar
  34. 34.
    Enker WE, Thaler HT, Cranor ML, Polyak T. Total mesorectal excision in the operative treatment of carcinoma of the rectum. JAm Coll Surg 1995; 181 (4): 335–346.Google Scholar
  35. 35.
    Heald RJ, Moran BJ, Ryall RD, et al. Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978–1997. Arch Surg 1998; 133 (8): 894–899.PubMedCrossRefGoogle Scholar
  36. 36.
    Arenas RB, Fichera A, Mhoon D, Michelassi F. Total mesenteric excision in the surgical treatment of rectal cancer: a prospective study. Arch Surg 1998; 133 (6): 608–612.PubMedCrossRefGoogle Scholar
  37. 37.
    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 (9): 638–646.PubMedCrossRefGoogle Scholar
  38. 38.
    Haller DG. Defining the optimal therapy for rectal cancer [letter]. JNatl Cancer Inst 2000; 92 (5): 361–362.CrossRefGoogle Scholar
  39. 39.
    Willett CG, Badizadegan K, Ancukiewicz M, Shellito PC. Prognostic factors in stage T3NO rectal cancer: do all patients require postoperative pelvic irradiation and chemotherapy? Dis Colon Rectum 1999; 42 (2): 167–173.PubMedCrossRefGoogle Scholar
  40. 40.
    Swedish Rectal Cancer Trial. Improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med 1997; 336: 980–987.CrossRefGoogle Scholar
  41. 41.
    Camma C, Giunta M, Fiorica F, et al. Preoperative radiotherapy for resectable rectal cancer: A meta-analysis. JAm Med Assoc 2000; 284: 1008–1015.CrossRefGoogle Scholar
  42. 42.
    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 (2): 289–295.PubMedCrossRefGoogle Scholar
  43. 43.
    Bosset JF, Magnin V, Maingon P, et al. Preoperative radiochemotherapy in rectal cancer: long-term results of a phase II trial. Int J Radiat Oncol Biol Phys 2000; 46 (2): 323–327.PubMedCrossRefGoogle Scholar
  44. 44.
    Rich TA, Skibber JM, Ajani J, et al. Preoperative infusional chemoradiation therapy for stage T3 rectal cancer. Int J Radiat Oncol Biol Phys 1995; 32 (4): 1025–1029.PubMedCrossRefGoogle Scholar
  45. 45.
    Mohiuddin M, Hayne M, Regine WF, et al. Prognostic significance of postchemoradiation stage following preoperative chemotherapy and radiation for advanced/recurrent rectal cancers. Int J Radiat Oncol Biol Phys 2000; 48: 1075–1080.PubMedCrossRefGoogle Scholar
  46. 46.
    Chari RS, Tyler DS, Anscher MS, et al. Preoperative radiation and chemotherapy in the treatment of adenocarcinoma of the rectum. Ann Surg 1995; 221 (6): 778–787.PubMedCrossRefGoogle Scholar
  47. 47.
    Chan AKP, Wong AO, Langevin J, et al. Preoperative chemotherapy and pelvic radiation for tethered or fixed rectal cancer: a phase II dose escalation study. Int J Radiat Oncol Biol Phys 2000; 48: 845–856.Google Scholar
  48. 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; 44 (5): 1027–1038.PubMedCrossRefGoogle Scholar
  49. 49.
    Minsky BD. Primary treatment of rectal cancer: present and future. Crit Rev Oncol Hematol 1999; 32: 19–30.PubMedCrossRefGoogle Scholar
  50. 50.
    Hyams DM, Mamounas EP, Petrelli N, et al. A clinical trial to evaluate the worth of preoperative multimodality therapy in patients with operable carcinoma of the rectum: a progress report of a national surgical adjuvant Breast and Bowel Project protocol R-03. Dis Col Rectum 1997; 40: 131–139.CrossRefGoogle Scholar
  51. 51.
    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.PubMedCrossRefGoogle Scholar
  52. 52.
    Valentini V, Coco C, Cellini N, et al. Preoperative chemoradiation for extraperitoneal T3 rectal cancer: acute toxicity, tumor response, and sphincter preservation. Int J Radiat Oncol Biol Phys 1998; 40: 1067–1075.PubMedCrossRefGoogle Scholar
  53. 53.
    Sauer R, Fietkau R, Martus P, et al. Adjuvant and neoadjuvant radiochemotherapy or advanced rectal cancer - first results of the German multicenter phase-III-trial [abstract]. Int J Radiat Oncol Biol Phys 2000; 48 (3 Suppl): 119a.CrossRefGoogle Scholar
  54. 54.
    Francois Y, Nemoz CJ, Baulieux J, et al. Influence of the interval between preoperative radiation therapy and surgery on downstaging and on the rate of sphincter-sparing surgery for rectal cancer: the Lyon R9001 randomized trial. J Clin Oncol 1999; 17 (8): 2396–2402.PubMedGoogle Scholar
  55. 55.
    Stahl TJ, Murray JJ, Coller JA, et al. Sphincter-saving alternative in the management of adenocarcinoma involving the distal rectum: 5-year follow-up results in 45 patients. Arch Surg 1993; 128: 545–550.PubMedCrossRefGoogle Scholar
  56. 56.
    Papillon J, Berard P. Endocavitary irradiation in the conservative treatment of adenocarcinoma of the low rectum. World J Surg 1992; 16: 451–457.PubMedCrossRefGoogle Scholar
  57. 57.
    Bleday R, Breen E, Jessup JM, et al. Prospective evaluation of local excision for small rectal cancer. Dis Colon Rectum 1997; 40: 388–392.PubMedCrossRefGoogle Scholar
  58. 58.
    Ota DM, Skibber J, Rich TA. M.D. Anderson Cancer Center experience with local excision and multimodality therapy for rectal cancer. Surg Oncol Clin North Am 1992; 1: 147–152.Google Scholar
  59. 59.
    Steele GD, Herndon JE, Bleday R, et al. Sphincter-sparing treatment for distal rectal adenocarcinoma. Ann Surg Oncol 1999; 6: 433–441.PubMedCrossRefGoogle Scholar
  60. 60.
    Willett CG, Compton CC, Shellito PC, Efird JT. Selection factors for local excision or abdominoperineal resection of early stage rectal cancer. Cancer 1994; 73: 2716–2720.PubMedCrossRefGoogle Scholar
  61. 61.
    Chakravarti A, Compton CC, Shellito PC, et al. Long-term follow-up of patients with rectal cancer managed by local excision with and without adjuvant irradiation. Ann Surg 1999; 230 (1): 49–54.PubMedCrossRefGoogle Scholar
  62. 62.
    Wagman 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.PubMedCrossRefGoogle Scholar
  63. 63.
    Saltz LB, Cox JV, Blanke C, et al. Irinotecan plus fluorouracil and leucovorin for metastatic colorectal cancer. N Engl J Med 2000; 343: 905–914.PubMedCrossRefGoogle Scholar
  64. 64.
    Anne P, Mitchell EP, Ahmad N, et al. Radiosensitization in locally advanced adenocarcinoma of the rectum using combined modality therapy (CMT) with CPT-11,5-fluorouracil concomitant irradiation [Abstract]. Proc Am Soc Clin Assoc 2000; 19: 250a.Google Scholar
  65. 65.
    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 Oncol Biol Phys 1999; 45 (3): 629–634.PubMedCrossRefGoogle Scholar
  66. 66.
    Hoff PM, Janjan N, Saad ED, et al. Phase I study of preoperative oral uracil and tegafur plus leucovorin and radiation therapy in rectal cancer. J Clin Oncol 2000; 18 (20): 3529–3534.PubMedGoogle Scholar
  67. 67.
    Dunst J, Reese T, Frings S. Phase I study of capecitabine combined with standard radiotherapy in patients with rectal cancer. Proc Am Soc Clin Oncol 2000; 19: 256a.Google Scholar
  68. 68.
    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 (2): 217–225.PubMedCrossRefGoogle Scholar
  69. 69.
    Levi F, Zidani R, Misset JL. Randomized multicentre trial of chronotherapy with oxaliplatin, fluorouracil, and folinic acid in metastatic colorectal cancer. Lancet 1997; 350: 681–686.PubMedCrossRefGoogle Scholar
  70. 70.
    Willett CG, Warland G, Coen J, et al. Rectal cancer: the influence of tumor proliferation on response to preoperative irradiation. Int J Radiat Oncol Biol Phys 1995; 32: 57–61.PubMedCrossRefGoogle Scholar
  71. 71.
    Willett CG, Hagan M, Daley W, et al. Changes in tumor proliferation of rectal cancer induced by preoperative 5-fluorouracil and irradiation. Dis Colon Rectum 1998; 41: 62–67.PubMedCrossRefGoogle Scholar
  72. 72.
    Qiu H, Sirivongs P, Rothenberger M, et al. Molecular prognostic factors in rectal cancer treated by radiation and surgery. Dis Colon Rectum 2000; 43: 451–459.PubMedCrossRefGoogle Scholar
  73. 73.
    Anne PR, Edmonston TB, Rose D, et al. Microsatellite instability predicts for tumor response in a prospective trial of preoperative 5-FU, CPT-11, and radiation for locally advanced rectal cancer [Abstract]. Int J Radiat Oncol Biol Phys 2000; 48 (3 Suppl): 121.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2003

Authors and Affiliations

  • Jason H. Lee
  • Christopher G. Willett

There are no affiliations available

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