title: Pre-operative chemo-radiotherapy in locally advanced rectal cancer: is this the way of future management?
abstract: The purpose of the present paper was to update a prospective analysis (H Elsaleh et al. unpubl. data, 1997) investigating the effectiveness and toxicity of pre-operative pelvic radiotherapy with modest dose 5-fluorouracil (5-FU) in locally advanced rectal cancer (T3-T4). A total of 31 patients were assessed (28 T3 and three T4 tumours). Pre-operative pelvic radiotherapy was delivered in four fields, 45 Gy to the International Commission on Radiation Units and Measurements (ICRU) point in 25 fractions over 5 weeks. A radiosensitizing dose of 5-FU was delivered at 500 mg/m2 on days 1, 2 and 3, and days 22, 23 and 24. Mesorectal excision of the rectal tumour either by anterior or abdomino-perineal resection was planned at 4-6 weeks from completion of pre-operative treatment. Response to therapy was assessed by fresh macroscopic measurement of the surgical specimen. Patients had a low toxicity profile; an estimated 50% or greater response was seen in 24 out of 31 (two complete responses). There were no surgical difficulties achieving resection. No late complications were documented, although follow-up was short. In locally advanced rectal cancer, pre-operative chemo-radiotherapy had a low toxicity profile. Appropriately fractionated pre-operative chemo-radiotherapy is a reasonable option in this disease and should be further evaluated. The optimal method of delivery of the radiosensitizing agent (5-FU) is the subject of further investigation.
authors.affiliation: Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Australia.
authors.forename: H
authors.initials: H
authors.lastname: Elsaleh
authors.forename: D
authors.initials: D
authors.lastname: Joseph
authors.forename: M
authors.initials: M
authors.lastname: Levitt
authors.forename: J
authors.initials: J
authors.lastname: Dewar
authors.forename: G
authors.initials: G
authors.lastname: Van Hazel
authors.forename: S
authors.initials: S
authors.lastname: Einhorn
authors.forename: F
authors.initials: F
authors.lastname: Cameron
authors.forename: M
authors.initials: M
authors.lastname: Osborne
authors.forename: M
authors.initials: M
authors.lastname: Latham
authors.forename: P
authors.initials: P
authors.lastname: Robbins
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil