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Radiation Therapy for Rectal Cancer

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Rectal Cancer

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Abstract

Radiation therapy plays an important role in the management of patients with rectal cancer. Radiation therapy can improve local control and increase sphincter preservation rates. Preoperative chemoradiation and preoperative short course radiotherapy are now considered standards of care for appropriate rectal cancer patients. Specific radiation therapy techniques such as reirradiation and intraoperative radiation therapy may also improve outcomes in selected patients with rectal cancer. This chapter will discuss the various roles of radiation therapy for rectal cancer and review modern approaches for radiation therapy delivery.

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References

  1. Douglass HO Jr, Moertel CG, Mayer RJ, Thomas PR, Lindblad AS, Mittleman A, et al. Survival after postoperative combination treatment of rectal cancer. N Engl J Med. 1986;315(20):1294–5.

    Article  PubMed  Google Scholar 

  2. Gastrointestinal Tumor Study Group. Prolongation of the disease-free interval in surgically treated rectal carcinoma. N Engl J Med. 1985;312(23):1465–72.

    Article  Google Scholar 

  3. Krook JE, Moertel CG, Gunderson LL, Wieand HS, Collins RT, Beart RW, et al. Effective surgical adjuvant therapy for high-risk rectal carcinoma. N Engl J Med. 1991;324(11):709–15.

    Article  CAS  PubMed  Google Scholar 

  4. Wolmark N, Wieand HS, Hyams DM, Colangelo L, Dimitrov NV, Romond EH, 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):388–96.

    Article  CAS  PubMed  Google Scholar 

  5. Sauer R, Becker H, Hohenberger W, Rodel C, Wittekind C, Fietkau R, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351(17):1731–40.

    Article  CAS  PubMed  Google Scholar 

  6. Sauer R, Liersch T, Merkel S, Fietkau R, Hohenberger W, Hess C, et al. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol. 2012;30(16):1926–33.

    Article  CAS  PubMed  Google Scholar 

  7. Roh MS, Colangelo LH, O'Connell MJ, Yothers G, Deutsch M, Allegra CJ, et al. Preoperative multimodality therapy improves disease-free survival in patients with carcinoma of the rectum: NSABP R-03. J Clin Oncol. 2009;27(31):5124–30.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Bosset JF, Collette L, Calais G, Mineur L, Maingon P, Radosevic-Jelic L, et al. Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med. 2006;355(11):1114–23.

    Article  CAS  PubMed  Google Scholar 

  9. Bosset JF, Calais G, Mineur L, Maingon P, Radosevic-Jelic L, Daban A, et al. Enhanced tumorocidal effect of chemotherapy with preoperative radiotherapy for rectal cancer: preliminary results--EORTC 22921. J Clin Oncol. 2005;23(24):5620–7.

    Article  CAS  PubMed  Google Scholar 

  10. Gerard JP, Conroy T, Bonnetain F, Bouche O, Chapet O, Closon-Dejardin MT, et al. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers: results of FFCD 9203. J Clin Oncol. 2006;24(28):4620–5.

    Article  PubMed  Google Scholar 

  11. Mak RH, McCarthy EP, Das P, Hong TS, Mamon HJ, Hoffman KE. Adoption of preoperative radiation therapy for rectal cancer from 2000 to 2006: a surveillance, epidemiology, and end results patterns-of-care study. Int J Radiat Oncol Biol Phys. 2011;80(4):978–84.

    Article  PubMed  Google Scholar 

  12. Swedish Rectal Cancer Trial. Improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med. 1997;336(14):980–7.

    Article  Google Scholar 

  13. Folkesson J, Birgisson H, Pahlman L, Cedermark B, Glimelius B, Gunnarsson U. Swedish rectal cancer trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol. 2005;23(24):5644–50.

    Article  PubMed  Google Scholar 

  14. Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 2001;345(9):638–46.

    Article  CAS  PubMed  Google Scholar 

  15. van Gijn W, Marijnen CA, Nagtegaal ID, Kranenbarg EM, Putter H, Wiggers T, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol. 2011;12(6):575–82.

    Article  PubMed  Google Scholar 

  16. Sebag-Montefiore D, Stephens RJ, Steele R, Monson J, Grieve R, Khanna S, et al. Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial. Lancet. 2009;373(9666):811–20.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Quirke P, Steele R, Monson J, Grieve R, Khanna S, Couture J, et al. Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. Lancet. 2009;373(9666):821–8.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Wiltink LM, Chen TY, Nout RA, Kranenbarg EM, Fiocco M, Laurberg S, et al. Health-related quality of life 14 years after preoperative short-term radiotherapy and total mesorectal excision for rectal cancer: report of a multicenter randomised trial. Eur J Cancer. 2014;50(14):2390–8.

    Article  PubMed  Google Scholar 

  19. Stephens RJ, Thompson LC, Quirke P, Steele R, Grieve R, Couture J, et al. Impact of short-course preoperative radiotherapy for rectal cancer on patients’ quality of life: data from the Medical Research Council CR07/National Cancer Institute of Canada clinical trials group C016 randomized clinical trial. J Clin Oncol. 2010;28(27):4233–9.

    Article  PubMed  Google Scholar 

  20. Bujko K, Nowacki MP, Nasierowska-Guttmejer A, Michalski W, Bebenek M, Kryj M. Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer. Br J Surg. 2006;93(10):1215–23.

    Article  CAS  PubMed  Google Scholar 

  21. Ngan SY, Burmeister B, Fisher RJ, Solomon M, Goldstein D, Joseph D, et al. Randomized trial of short-course radiotherapy versus long-course chemoradiation comparing rates of local recurrence in patients with T3 rectal cancer: Trans-Tasman radiation oncology group trial 01.04. J Clin Oncol. 2012;30(31):3827–33.

    Article  PubMed  Google Scholar 

  22. Radu C, Berglund A, Pahlman L, Glimelius B. Short-course preoperative radiotherapy with delayed surgery in rectal cancer - a retrospective study. Radiother Oncol. 2008;87(3):343–9.

    Article  PubMed  Google Scholar 

  23. Hatfield P, Hingorani M, Radhakrishna G, Cooper R, Melcher A, Crellin A, et al. Short-course radiotherapy, with elective delay prior to surgery, in patients with unresectable rectal cancer who have poor performance status or significant co-morbidity. Radiother Oncol. 2009;92(2):210–4.

    Article  PubMed  Google Scholar 

  24. Pettersson D, Glimelius B, Iversen H, Johansson H, Holm T, Martling A. Impaired postoperative leucocyte counts after preoperative radiotherapy for rectal cancer in the Stockholm III trial. Br J Surg. 2013;100(7):969–75.

    Article  CAS  PubMed  Google Scholar 

  25. Habr-Gama A, Perez RO, Proscurshim I, Campos FG, Nadalin W, Kiss D, et al. Patterns of failure and survival for nonoperative treatment of stage c0 distal rectal cancer following neoadjuvant chemoradiation therapy. J Gastrointest Surg. 2006;10(10):1319–28. discussion 28–9

    Article  PubMed  Google Scholar 

  26. Habr-Gama A, Perez RO, Nadalin W, Sabbaga J, Ribeiro U Jr, Silva e Sousa AH Jr, et al. Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results. Ann Surg. 2004;240(4):711–7. discussion 7–8

    PubMed  PubMed Central  Google Scholar 

  27. Maas M, Beets-Tan RG, Lambregts DM, Lammering G, Nelemans PJ, Engelen SM, et al. Wait-and-see policy for clinical complete responders after chemoradiation for rectal cancer. J Clin Oncol. 2011;29(35):4633–40.

    Article  PubMed  Google Scholar 

  28. Smith JD, Ruby JA, Goodman KA, Saltz LB, Guillem JG, Weiser MR, et al. Nonoperative management of rectal cancer with complete clinical response after neoadjuvant therapy. Ann Surg. 2012;256(6):965–72.

    Article  PubMed  Google Scholar 

  29. Hughes R, Harrison M, Glynne-Jones R. Could a wait and see policy be justified in T3/4 rectal cancers after chemo-radiotherapy? Acta Oncol. 2010;49(3):378–81.

    Article  PubMed  Google Scholar 

  30. Nakagawa WT, Rossi BM, de OFF, Ferrigno R, David Filho WJ, Nishimoto IN, et al. Chemoradiation instead of surgery to treat mid and low rectal tumors: is it safe? Ann Surg Oncol. 2002;9(6):568–73.

    Article  PubMed  Google Scholar 

  31. Rossi BM, Nakagawa WT, Novaes PE, Filho WD, Lopes A. Radiation and chemotherapy instead of surgery for low infiltrative rectal adenocarcinoma: a prospective trial. Ann Surg Oncol. 1998;5(2):113–8.

    Article  CAS  PubMed  Google Scholar 

  32. Callender GG, Das P, Rodriguez-Bigas MA, Skibber JM, Crane CH, Krishnan S, et al. Local excision after preoperative chemoradiation results in an equivalent outcome to total mesorectal excision in selected patients with T3 rectal cancer. Ann Surg Oncol. 2010;17(2):441–7.

    Article  PubMed  Google Scholar 

  33. Lee NK, Kim DY, Kim SY, JH O, Park W, Choi DH, et al. Clinical outcomes of local excision following preoperative chemoradiotherapy for locally advanced rectal cancer. Cancer Res Treat. 2014;46(2):158–64.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Nair RM, Siegel EM, Chen DT, Fulp WJ, Yeatman TJ, Malafa MP, et al. Long-term results of transanal excision after neoadjuvant chemoradiation for T2 and T3 adenocarcinomas of the rectum. J Gastrointest Surg. 2008;12(10):1797–805. discussion 805–6

    Article  PubMed  Google Scholar 

  35. Garcia-Aguilar J, Shi Q, Thomas CR Jr, Chan E, Cataldo P, Marcet J, et al. A phase II trial of neoadjuvant chemoradiation and local excision for T2N0 rectal cancer: preliminary results of the ACOSOG Z6041 trial. Ann Surg Oncol. 2012;19(2):384–91.

    Article  PubMed  Google Scholar 

  36. Gunderson LL, Sargent DJ, Tepper JE, Wolmark N, O'Connell MJ, Begovic M, et al. Impact of T and N stage and treatment on survival and relapse in adjuvant rectal cancer: a pooled analysis. J Clin Oncol. 2004;22(10):1785–96.

    Article  PubMed  Google Scholar 

  37. Taylor FG, Quirke P, Heald RJ, Moran B, Blomqvist L, Swift I, et al. Preoperative high-resolution magnetic resonance imaging can identify good prognosis stage I, II, and III rectal cancer best managed by surgery alone: a prospective, multicenter, European study. Ann Surg. 2011;253(4):711–9.

    Article  PubMed  Google Scholar 

  38. Schrag D, Weiser MR, Goodman KA, Gonen M, Hollywood E, Cercek A, et al. Neoadjuvant chemotherapy without routine use of radiation therapy for patients with locally advanced rectal cancer: a pilot trial. J Clin Oncol. 2014;32(6):513–8.

    Article  CAS  PubMed  Google Scholar 

  39. Mohiuddin M, Lingareddy V, Rakinic J, Marks G. Reirradiation for rectal cancer and surgical resection after ultra high doses. Int J Radiat Oncol Biol Phys. 1993;27(5):1159–63.

    Article  CAS  PubMed  Google Scholar 

  40. Lingareddy V, Ahmad NR, Mohiuddin M. Palliative reirradiation for recurrent rectal cancer. Int J Radiat Oncol Biol Phys. 1997;38(4):785–90.

    Article  CAS  PubMed  Google Scholar 

  41. Mohiuddin M, Marks GM, Lingareddy V, Marks J. Curative surgical resection following reirradiation for recurrent rectal cancer. Int J Radiat Oncol Biol Phys. 1997;39(3):643–9.

    Article  CAS  PubMed  Google Scholar 

  42. Mohiuddin M, Marks G, Marks J. Long-term results of reirradiation for patients with recurrent rectal carcinoma. Cancer. 2002;95(5):1144–50.

    Article  PubMed  Google Scholar 

  43. Valentini V, Morganti AG, Gambacorta MA, Mohiuddin M, Doglietto GB, Coco C, et al. Preoperative hyperfractionated chemoradiation for locally recurrent rectal cancer in patients previously irradiated to the pelvis: a multicentric phase II study. Int J Radiat Oncol Biol Phys. 2006;64(4):1129–39.

    Article  PubMed  Google Scholar 

  44. Das P, Delclos ME, Skibber JM, Rodriguez-Bigas MA, Feig BW, Chang GJ, et al. Hyperfractionated accelerated radiotherapy for rectal cancer in patients with prior pelvic irradiation. Int J Radiat Oncol Biol Phys. 2010;77(1):60–5.

    Article  PubMed  Google Scholar 

  45. Ng MK, Leong T, Heriot AG, Ngan SY. Once-daily reirradiation for rectal cancer in patients who have received previous pelvic radiotherapy. J Med Imaging Radiat Oncol. 2013;57(4):512–8.

    Article  PubMed  Google Scholar 

  46. Bosman SJ, Holman FA, Nieuwenhuijzen GA, Martijn H, Creemers GJ, Rutten HJ. Feasibility of reirradiation in the treatment of locally recurrent rectal cancer. Br J Surg. 2014;101(10):1280–9.

    Article  CAS  PubMed  Google Scholar 

  47. Willett CG, Czito BG, Tyler DS. Intraoperative radiation therapy. J Clin Oncol. 2007;25(8):971–7.

    Article  PubMed  Google Scholar 

  48. Mathis KL, Nelson H, Pemberton JH, Haddock MG, Gunderson LL. Unresectable colorectal cancer can be cured with multimodality therapy. Ann Surg. 2008;248(4):592–8.

    PubMed  Google Scholar 

  49. Haddock MG, Miller RC, Nelson H, Pemberton JH, Dozois EJ, Alberts SR, et al. Combined modality therapy including intraoperative electron irradiation for locally recurrent colorectal cancer. Int J Radiat Oncol Biol Phys. 2011;79(1):143–50.

    Article  PubMed  Google Scholar 

  50. Hyngstrom JR, Tzeng CW, Beddar S, Das P, Krishnan S, Delclos ME, et al. Intraoperative radiation therapy for locally advanced primary and recurrent colorectal cancer: ten-year institutional experience. J Surg Oncol. 2014;109(7):652–8.

    Article  PubMed  Google Scholar 

  51. Alberda WJ, Verhoef C, Nuyttens JJ, van Meerten E, Rothbarth J, de Wilt JH, et al. Intraoperative radiation therapy reduces local recurrence rates in patients with microscopically involved circumferential resection margins after resection of locally advanced rectal cancer. Int J Radiat Oncol Biol Phys. 2014;88(5):1032–40.

    Article  PubMed  Google Scholar 

  52. Kusters M, Valentini V, Calvo FA, Krempien R, Nieuwenhuijzen GA, Martijn H, et al. Results of European pooled analysis of IORT-containing multimodality treatment for locally advanced rectal cancer: adjuvant chemotherapy prevents local recurrence rather than distant metastases. Ann Oncol. 2010;21(6):1279–84.

    Article  CAS  PubMed  Google Scholar 

  53. Mirnezami R, Chang GJ, Das P, Chandrakumaran K, Tekkis P, Darzi A, et al. Intraoperative radiotherapy in colorectal cancer: systematic review and meta-analysis of techniques, long-term outcomes, and complications. Surg Oncol. 2013;22(1):22–35.

    Article  PubMed  Google Scholar 

  54. Guerrero Urbano MT, Henrys AJ, Adams EJ, Norman AR, Bedford JL, Harrington KJ, et al. Intensity-modulated radiotherapy in patients with locally advanced rectal cancer reduces volume of bowel treated to high dose levels. Int J Radiat Oncol Biol Phys. 2006;65(3):907–16.

    Article  PubMed  Google Scholar 

  55. Arbea L, Ramos LI, Martinez-Monge R, Moreno M, Aristu J. Intensity-modulated radiation therapy (IMRT) vs. 3D conformal radiotherapy (3DCRT) in locally advanced rectal cancer (LARC): dosimetric comparison and clinical implications. Radiat Oncol. 2010;5:17.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Mok H, Crane CH, Palmer MB, Briere TM, Beddar S, Delclos ME, et al. Intensity modulated radiation therapy (IMRT): differences in target volumes and improvement in clinically relevant doses to small bowel in rectal carcinoma. Radiat Oncol. 2011;6:63.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Samuelian JM, Callister MD, Ashman JB, Young-Fadok TM, Borad MJ, Gunderson LL. Reduced acute bowel toxicity in patients treated with intensity-modulated radiotherapy for rectal cancer. Int J Radiat Oncol Biol Phys. 2012;82(5):1981–7.

    Article  PubMed  Google Scholar 

  58. Parekh A, Truong MT, Pashtan I, Qureshi MM, Martin NE, Nawaz O, et al. Acute gastrointestinal toxicity and tumor response with preoperative intensity modulated radiation therapy for rectal cancer. Gastrointest Cancer Res. 2013;6(5–6):137–43.

    PubMed  PubMed Central  Google Scholar 

  59. Jabbour SK, Patel S, Herman JM, Wild A, Nagda SN, Altoos T, et al. Intensity-modulated radiation therapy for rectal carcinoma can reduce treatment breaks and emergency department visits. Int J Surg Oncol. 2012;2012:891067.

    PubMed  PubMed Central  Google Scholar 

  60. Garofalo M, Moughan J, Hong T, Bendell J, Berger A, Lerma F, et al. RTOG 0822: a phase II study or preoperative chemoradiotherapy utilizing IMRT in combination with capecitabine and oxaliplatin for patients with locally advanced rectal cancer. Int J Radiat Oncol Biol Phys. 2011;81(2S):Abstr 6.

    Google Scholar 

  61. Bruheim K, Guren MG, Skovlund E, Hjermstad MJ, Dahl O, Frykholm G, et al. Late side effects and quality of life after radiotherapy for rectal cancer. Int J Radiat Oncol Biol Phys. 2010;76(4):1005–11.

    Article  PubMed  Google Scholar 

  62. Bruheim K, Tveit KM, Skovlund E, Balteskard L, Carlsen E, Fossa SD, et al. Sexual function in females after radiotherapy for rectal cancer. Acta Oncol. 2010;49(6):826–32.

    Article  PubMed  Google Scholar 

  63. Bruheim K, Guren MG, Dahl AA, Skovlund E, Balteskard L, Carlsen E, et al. Sexual function in males after radiotherapy for rectal cancer. Int J Radiat Oncol Biol Phys. 2010;76(4):1012–7.

    Article  PubMed  Google Scholar 

  64. Baglan KL, Frazier RC, Yan D, Huang RR, Martinez AA, Robertson JM. The dose-volume relationship of acute small bowel toxicity from concurrent 5-FU-based chemotherapy and radiation therapy for rectal cancer. Int J Radiat Oncol Biol Phys. 2002;52(1):176–83.

    Article  PubMed  Google Scholar 

  65. Robertson JM, Lockman D, Yan D, Wallace M. The dose-volume relationship of small bowel irradiation and acute grade 3 diarrhea during chemoradiotherapy for rectal cancer. Int J Radiat Oncol Biol Phys. 2008;70(2):413–8.

    Article  CAS  PubMed  Google Scholar 

  66. Robertson JM, Sohn M, Yan D. Predicting grade 3 acute diarrhea during radiation therapy for rectal cancer using a cutoff-dose logistic regression normal tissue complication probability model. Int J Radiat Oncol Biol Phys. 2010;77(1):66–72.

    Article  PubMed  Google Scholar 

  67. Jones WE 3rd, Thomas CR Jr, Herman JM, Abdel-Wahab M, Azad N, Blackstock W, et al. ACR appropriateness criteria(R) resectable rectal cancer. Radiat Oncol. 2012;7:161.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 97, Houston, TX, 77030, USA

    Prajnan Das & Bruce D. Minsky

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  1. Prajnan Das
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  2. Bruce D. Minsky
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Correspondence to Prajnan Das .

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  1. Department of Surgical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA

    George J. Chang

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Das, P., Minsky, B.D. (2018). Radiation Therapy for Rectal Cancer. In: Chang, G. (eds) Rectal Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-16384-0_5

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  • DOI: https://doi.org/10.1007/978-3-319-16384-0_5

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