Successful Downstaging of High Rectal and Recto-Sigmoid Cancer by Neo-Adjuvant Chemo-Radiotherapy

Purpose The benefit of neoadjuvant therapy for tumours above the peritoneal reflection is not clear. The purpose of this study is to demonstrate the feasibility and downstaging of treating locally advanced tumours from high rectum to distal sigmoid with preoperative chemoradiotherapy (CRT). Methods...
Ausführliche Beschreibung

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Autor*in:	Brian O'neill F.F.R.R.C.S.I. [verfasserIn] Gina Brown [verfasserIn] Andrew Wotherspoon [verfasserIn] Sarah Burton [verfasserIn] Andy Norman [verfasserIn] Diana Tait [verfasserIn]

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2008

Übergeordnetes Werk:	In: Clinical Medicine Insights: Oncology - SAGE Publishing, 2012, 2(2008)
Übergeordnetes Werk:	volume:2 ; year:2008

Links:	Link aufrufen Link aufrufen Link aufrufen Journal toc

DOI / URN:	10.4137/CMO.S348

Katalog-ID:	DOAJ048524387

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520			\|a Purpose The benefit of neoadjuvant therapy for tumours above the peritoneal reflection is not clear. The purpose of this study is to demonstrate the feasibility and downstaging of treating locally advanced tumours from high rectum to distal sigmoid with preoperative chemoradiotherapy (CRT). Methods and Materials Seventeen patients with high rectal, recto-sigmoid or distal sigmoid tumours above the peritoneal reflection received neo-adjuvant CRT, selected on MRI findings indicating T4 disease or threatened circumferential resection margin. All patients were administered neoadjuvant chemotherapy, with Oxaliplatin or Mitomycin C and a Fluoropyrimidine. The pelvis received long-course CT-planned conformal RT, 45 Gy in 25 fractions, with a boost of 5.4–9 Gy in 3–5 fractions. Thirteen patients were treated with concomitant oral or intravenous Fluoropyrimidine chemotherapy. Results Median follow-up was 37 months. Overall survival was 82.35% (95% Confidence Interval (CI) 54.7–93.9) and disease free survival 81.25% (95% CI 52.5–93.5). Only 1 patient suffered loco-regional relapse. Chemotherapy regimens were well tolerated, though some patients required dose reductions. Nine patients (52.9%) lowered pathologic disease AJCC stage, i.e. ‘downstaged’. Six patients (35.3%) achieved complete pathological response. Clear margins were attained in all but 1 patient. Three patients were converted from cT4 to ypT3. No patient required a gap during CRT. One patient suffered a grade III acute toxicity, but no grade IV (RTOG). There were 3 grade III and 3 grade IV late toxicities (LENT-SOMA). Conclusions Locally advanced high rectal and recto-sigmoid tumours may be treated with pre-operative CRT with acceptable toxicity, impressive down-staging, and clear surgical margins.
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allfields	10.4137/CMO.S348 doi (DE-627)DOAJ048524387 (DE-599)DOAJf6ad7f3422aa4f918aae6d9ecc9e5287 DE-627 ger DE-627 rakwb eng RC254-282 Brian O'neill F.F.R.R.C.S.I. verfasserin aut Successful Downstaging of High Rectal and Recto-Sigmoid Cancer by Neo-Adjuvant Chemo-Radiotherapy 2008 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Purpose The benefit of neoadjuvant therapy for tumours above the peritoneal reflection is not clear. The purpose of this study is to demonstrate the feasibility and downstaging of treating locally advanced tumours from high rectum to distal sigmoid with preoperative chemoradiotherapy (CRT). Methods and Materials Seventeen patients with high rectal, recto-sigmoid or distal sigmoid tumours above the peritoneal reflection received neo-adjuvant CRT, selected on MRI findings indicating T4 disease or threatened circumferential resection margin. All patients were administered neoadjuvant chemotherapy, with Oxaliplatin or Mitomycin C and a Fluoropyrimidine. The pelvis received long-course CT-planned conformal RT, 45 Gy in 25 fractions, with a boost of 5.4–9 Gy in 3–5 fractions. Thirteen patients were treated with concomitant oral or intravenous Fluoropyrimidine chemotherapy. Results Median follow-up was 37 months. Overall survival was 82.35% (95% Confidence Interval (CI) 54.7–93.9) and disease free survival 81.25% (95% CI 52.5–93.5). Only 1 patient suffered loco-regional relapse. Chemotherapy regimens were well tolerated, though some patients required dose reductions. Nine patients (52.9%) lowered pathologic disease AJCC stage, i.e. ‘downstaged’. Six patients (35.3%) achieved complete pathological response. Clear margins were attained in all but 1 patient. Three patients were converted from cT4 to ypT3. No patient required a gap during CRT. One patient suffered a grade III acute toxicity, but no grade IV (RTOG). There were 3 grade III and 3 grade IV late toxicities (LENT-SOMA). Conclusions Locally advanced high rectal and recto-sigmoid tumours may be treated with pre-operative CRT with acceptable toxicity, impressive down-staging, and clear surgical margins. Neoplasms. Tumors. Oncology. Including cancer and carcinogens Gina Brown verfasserin aut Andrew Wotherspoon verfasserin aut Sarah Burton verfasserin aut Andy Norman verfasserin aut Diana Tait verfasserin aut In Clinical Medicine Insights: Oncology SAGE Publishing, 2012 2(2008) (DE-627)63742266X (DE-600)2577877-8 11795549 nnns volume:2 year:2008 https://doi.org/10.4137/CMO.S348 kostenfrei https://doaj.org/article/f6ad7f3422aa4f918aae6d9ecc9e5287 kostenfrei https://doi.org/10.4137/CMO.S348 kostenfrei https://doaj.org/toc/1179-5549 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_95 GBV_ILN_110 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 AR 2 2008
spelling	10.4137/CMO.S348 doi (DE-627)DOAJ048524387 (DE-599)DOAJf6ad7f3422aa4f918aae6d9ecc9e5287 DE-627 ger DE-627 rakwb eng RC254-282 Brian O'neill F.F.R.R.C.S.I. verfasserin aut Successful Downstaging of High Rectal and Recto-Sigmoid Cancer by Neo-Adjuvant Chemo-Radiotherapy 2008 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Purpose The benefit of neoadjuvant therapy for tumours above the peritoneal reflection is not clear. The purpose of this study is to demonstrate the feasibility and downstaging of treating locally advanced tumours from high rectum to distal sigmoid with preoperative chemoradiotherapy (CRT). Methods and Materials Seventeen patients with high rectal, recto-sigmoid or distal sigmoid tumours above the peritoneal reflection received neo-adjuvant CRT, selected on MRI findings indicating T4 disease or threatened circumferential resection margin. All patients were administered neoadjuvant chemotherapy, with Oxaliplatin or Mitomycin C and a Fluoropyrimidine. The pelvis received long-course CT-planned conformal RT, 45 Gy in 25 fractions, with a boost of 5.4–9 Gy in 3–5 fractions. Thirteen patients were treated with concomitant oral or intravenous Fluoropyrimidine chemotherapy. Results Median follow-up was 37 months. Overall survival was 82.35% (95% Confidence Interval (CI) 54.7–93.9) and disease free survival 81.25% (95% CI 52.5–93.5). Only 1 patient suffered loco-regional relapse. Chemotherapy regimens were well tolerated, though some patients required dose reductions. Nine patients (52.9%) lowered pathologic disease AJCC stage, i.e. ‘downstaged’. Six patients (35.3%) achieved complete pathological response. Clear margins were attained in all but 1 patient. Three patients were converted from cT4 to ypT3. No patient required a gap during CRT. One patient suffered a grade III acute toxicity, but no grade IV (RTOG). There were 3 grade III and 3 grade IV late toxicities (LENT-SOMA). Conclusions Locally advanced high rectal and recto-sigmoid tumours may be treated with pre-operative CRT with acceptable toxicity, impressive down-staging, and clear surgical margins. Neoplasms. Tumors. Oncology. Including cancer and carcinogens Gina Brown verfasserin aut Andrew Wotherspoon verfasserin aut Sarah Burton verfasserin aut Andy Norman verfasserin aut Diana Tait verfasserin aut In Clinical Medicine Insights: Oncology SAGE Publishing, 2012 2(2008) (DE-627)63742266X (DE-600)2577877-8 11795549 nnns volume:2 year:2008 https://doi.org/10.4137/CMO.S348 kostenfrei https://doaj.org/article/f6ad7f3422aa4f918aae6d9ecc9e5287 kostenfrei https://doi.org/10.4137/CMO.S348 kostenfrei https://doaj.org/toc/1179-5549 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_95 GBV_ILN_110 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 AR 2 2008
allfields_unstemmed	10.4137/CMO.S348 doi (DE-627)DOAJ048524387 (DE-599)DOAJf6ad7f3422aa4f918aae6d9ecc9e5287 DE-627 ger DE-627 rakwb eng RC254-282 Brian O'neill F.F.R.R.C.S.I. verfasserin aut Successful Downstaging of High Rectal and Recto-Sigmoid Cancer by Neo-Adjuvant Chemo-Radiotherapy 2008 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Purpose The benefit of neoadjuvant therapy for tumours above the peritoneal reflection is not clear. The purpose of this study is to demonstrate the feasibility and downstaging of treating locally advanced tumours from high rectum to distal sigmoid with preoperative chemoradiotherapy (CRT). Methods and Materials Seventeen patients with high rectal, recto-sigmoid or distal sigmoid tumours above the peritoneal reflection received neo-adjuvant CRT, selected on MRI findings indicating T4 disease or threatened circumferential resection margin. All patients were administered neoadjuvant chemotherapy, with Oxaliplatin or Mitomycin C and a Fluoropyrimidine. The pelvis received long-course CT-planned conformal RT, 45 Gy in 25 fractions, with a boost of 5.4–9 Gy in 3–5 fractions. Thirteen patients were treated with concomitant oral or intravenous Fluoropyrimidine chemotherapy. Results Median follow-up was 37 months. Overall survival was 82.35% (95% Confidence Interval (CI) 54.7–93.9) and disease free survival 81.25% (95% CI 52.5–93.5). Only 1 patient suffered loco-regional relapse. Chemotherapy regimens were well tolerated, though some patients required dose reductions. Nine patients (52.9%) lowered pathologic disease AJCC stage, i.e. ‘downstaged’. Six patients (35.3%) achieved complete pathological response. Clear margins were attained in all but 1 patient. Three patients were converted from cT4 to ypT3. No patient required a gap during CRT. One patient suffered a grade III acute toxicity, but no grade IV (RTOG). There were 3 grade III and 3 grade IV late toxicities (LENT-SOMA). Conclusions Locally advanced high rectal and recto-sigmoid tumours may be treated with pre-operative CRT with acceptable toxicity, impressive down-staging, and clear surgical margins. Neoplasms. Tumors. Oncology. Including cancer and carcinogens Gina Brown verfasserin aut Andrew Wotherspoon verfasserin aut Sarah Burton verfasserin aut Andy Norman verfasserin aut Diana Tait verfasserin aut In Clinical Medicine Insights: Oncology SAGE Publishing, 2012 2(2008) (DE-627)63742266X (DE-600)2577877-8 11795549 nnns volume:2 year:2008 https://doi.org/10.4137/CMO.S348 kostenfrei https://doaj.org/article/f6ad7f3422aa4f918aae6d9ecc9e5287 kostenfrei https://doi.org/10.4137/CMO.S348 kostenfrei https://doaj.org/toc/1179-5549 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_95 GBV_ILN_110 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 AR 2 2008
allfieldsGer	10.4137/CMO.S348 doi (DE-627)DOAJ048524387 (DE-599)DOAJf6ad7f3422aa4f918aae6d9ecc9e5287 DE-627 ger DE-627 rakwb eng RC254-282 Brian O'neill F.F.R.R.C.S.I. verfasserin aut Successful Downstaging of High Rectal and Recto-Sigmoid Cancer by Neo-Adjuvant Chemo-Radiotherapy 2008 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Purpose The benefit of neoadjuvant therapy for tumours above the peritoneal reflection is not clear. The purpose of this study is to demonstrate the feasibility and downstaging of treating locally advanced tumours from high rectum to distal sigmoid with preoperative chemoradiotherapy (CRT). Methods and Materials Seventeen patients with high rectal, recto-sigmoid or distal sigmoid tumours above the peritoneal reflection received neo-adjuvant CRT, selected on MRI findings indicating T4 disease or threatened circumferential resection margin. All patients were administered neoadjuvant chemotherapy, with Oxaliplatin or Mitomycin C and a Fluoropyrimidine. The pelvis received long-course CT-planned conformal RT, 45 Gy in 25 fractions, with a boost of 5.4–9 Gy in 3–5 fractions. Thirteen patients were treated with concomitant oral or intravenous Fluoropyrimidine chemotherapy. Results Median follow-up was 37 months. Overall survival was 82.35% (95% Confidence Interval (CI) 54.7–93.9) and disease free survival 81.25% (95% CI 52.5–93.5). Only 1 patient suffered loco-regional relapse. Chemotherapy regimens were well tolerated, though some patients required dose reductions. Nine patients (52.9%) lowered pathologic disease AJCC stage, i.e. ‘downstaged’. Six patients (35.3%) achieved complete pathological response. Clear margins were attained in all but 1 patient. Three patients were converted from cT4 to ypT3. No patient required a gap during CRT. One patient suffered a grade III acute toxicity, but no grade IV (RTOG). There were 3 grade III and 3 grade IV late toxicities (LENT-SOMA). Conclusions Locally advanced high rectal and recto-sigmoid tumours may be treated with pre-operative CRT with acceptable toxicity, impressive down-staging, and clear surgical margins. Neoplasms. Tumors. Oncology. Including cancer and carcinogens Gina Brown verfasserin aut Andrew Wotherspoon verfasserin aut Sarah Burton verfasserin aut Andy Norman verfasserin aut Diana Tait verfasserin aut In Clinical Medicine Insights: Oncology SAGE Publishing, 2012 2(2008) (DE-627)63742266X (DE-600)2577877-8 11795549 nnns volume:2 year:2008 https://doi.org/10.4137/CMO.S348 kostenfrei https://doaj.org/article/f6ad7f3422aa4f918aae6d9ecc9e5287 kostenfrei https://doi.org/10.4137/CMO.S348 kostenfrei https://doaj.org/toc/1179-5549 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_95 GBV_ILN_110 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 AR 2 2008
allfieldsSound	10.4137/CMO.S348 doi (DE-627)DOAJ048524387 (DE-599)DOAJf6ad7f3422aa4f918aae6d9ecc9e5287 DE-627 ger DE-627 rakwb eng RC254-282 Brian O'neill F.F.R.R.C.S.I. verfasserin aut Successful Downstaging of High Rectal and Recto-Sigmoid Cancer by Neo-Adjuvant Chemo-Radiotherapy 2008 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Purpose The benefit of neoadjuvant therapy for tumours above the peritoneal reflection is not clear. The purpose of this study is to demonstrate the feasibility and downstaging of treating locally advanced tumours from high rectum to distal sigmoid with preoperative chemoradiotherapy (CRT). Methods and Materials Seventeen patients with high rectal, recto-sigmoid or distal sigmoid tumours above the peritoneal reflection received neo-adjuvant CRT, selected on MRI findings indicating T4 disease or threatened circumferential resection margin. All patients were administered neoadjuvant chemotherapy, with Oxaliplatin or Mitomycin C and a Fluoropyrimidine. The pelvis received long-course CT-planned conformal RT, 45 Gy in 25 fractions, with a boost of 5.4–9 Gy in 3–5 fractions. Thirteen patients were treated with concomitant oral or intravenous Fluoropyrimidine chemotherapy. Results Median follow-up was 37 months. Overall survival was 82.35% (95% Confidence Interval (CI) 54.7–93.9) and disease free survival 81.25% (95% CI 52.5–93.5). Only 1 patient suffered loco-regional relapse. Chemotherapy regimens were well tolerated, though some patients required dose reductions. Nine patients (52.9%) lowered pathologic disease AJCC stage, i.e. ‘downstaged’. Six patients (35.3%) achieved complete pathological response. Clear margins were attained in all but 1 patient. Three patients were converted from cT4 to ypT3. No patient required a gap during CRT. One patient suffered a grade III acute toxicity, but no grade IV (RTOG). There were 3 grade III and 3 grade IV late toxicities (LENT-SOMA). Conclusions Locally advanced high rectal and recto-sigmoid tumours may be treated with pre-operative CRT with acceptable toxicity, impressive down-staging, and clear surgical margins. Neoplasms. Tumors. Oncology. Including cancer and carcinogens Gina Brown verfasserin aut Andrew Wotherspoon verfasserin aut Sarah Burton verfasserin aut Andy Norman verfasserin aut Diana Tait verfasserin aut In Clinical Medicine Insights: Oncology SAGE Publishing, 2012 2(2008) (DE-627)63742266X (DE-600)2577877-8 11795549 nnns volume:2 year:2008 https://doi.org/10.4137/CMO.S348 kostenfrei https://doaj.org/article/f6ad7f3422aa4f918aae6d9ecc9e5287 kostenfrei https://doi.org/10.4137/CMO.S348 kostenfrei https://doaj.org/toc/1179-5549 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_95 GBV_ILN_110 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 AR 2 2008
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container_title	Clinical Medicine Insights: Oncology
authorswithroles_txt_mv	Brian O'neill F.F.R.R.C.S.I. @@aut@@ Gina Brown @@aut@@ Andrew Wotherspoon @@aut@@ Sarah Burton @@aut@@ Andy Norman @@aut@@ Diana Tait @@aut@@
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The purpose of this study is to demonstrate the feasibility and downstaging of treating locally advanced tumours from high rectum to distal sigmoid with preoperative chemoradiotherapy (CRT). Methods and Materials Seventeen patients with high rectal, recto-sigmoid or distal sigmoid tumours above the peritoneal reflection received neo-adjuvant CRT, selected on MRI findings indicating T4 disease or threatened circumferential resection margin. All patients were administered neoadjuvant chemotherapy, with Oxaliplatin or Mitomycin C and a Fluoropyrimidine. The pelvis received long-course CT-planned conformal RT, 45 Gy in 25 fractions, with a boost of 5.4–9 Gy in 3–5 fractions. Thirteen patients were treated with concomitant oral or intravenous Fluoropyrimidine chemotherapy. Results Median follow-up was 37 months. Overall survival was 82.35% (95% Confidence Interval (CI) 54.7–93.9) and disease free survival 81.25% (95% CI 52.5–93.5). Only 1 patient suffered loco-regional relapse. Chemotherapy regimens were well tolerated, though some patients required dose reductions. Nine patients (52.9%) lowered pathologic disease AJCC stage, i.e. ‘downstaged’. Six patients (35.3%) achieved complete pathological response. Clear margins were attained in all but 1 patient. Three patients were converted from cT4 to ypT3. No patient required a gap during CRT. One patient suffered a grade III acute toxicity, but no grade IV (RTOG). There were 3 grade III and 3 grade IV late toxicities (LENT-SOMA). Conclusions Locally advanced high rectal and recto-sigmoid tumours may be treated with pre-operative CRT with acceptable toxicity, impressive down-staging, and clear surgical margins.</subfield></datafield><datafield tag="653" ind1=" " ind2="0"><subfield code="a">Neoplasms. Tumors. Oncology. 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callnumber-first	R - Medicine
author	Brian O'neill F.F.R.R.C.S.I.
spellingShingle	Brian O'neill F.F.R.R.C.S.I. misc RC254-282 misc Neoplasms. Tumors. Oncology. Including cancer and carcinogens Successful Downstaging of High Rectal and Recto-Sigmoid Cancer by Neo-Adjuvant Chemo-Radiotherapy
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topic_title	RC254-282 Successful Downstaging of High Rectal and Recto-Sigmoid Cancer by Neo-Adjuvant Chemo-Radiotherapy
topic	misc RC254-282 misc Neoplasms. Tumors. Oncology. Including cancer and carcinogens
topic_unstemmed	misc RC254-282 misc Neoplasms. Tumors. Oncology. Including cancer and carcinogens
topic_browse	misc RC254-282 misc Neoplasms. Tumors. Oncology. Including cancer and carcinogens
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title	Successful Downstaging of High Rectal and Recto-Sigmoid Cancer by Neo-Adjuvant Chemo-Radiotherapy
ctrlnum	(DE-627)DOAJ048524387 (DE-599)DOAJf6ad7f3422aa4f918aae6d9ecc9e5287
title_full	Successful Downstaging of High Rectal and Recto-Sigmoid Cancer by Neo-Adjuvant Chemo-Radiotherapy
author_sort	Brian O'neill F.F.R.R.C.S.I.
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title_sort	successful downstaging of high rectal and recto-sigmoid cancer by neo-adjuvant chemo-radiotherapy
callnumber	RC254-282
title_auth	Successful Downstaging of High Rectal and Recto-Sigmoid Cancer by Neo-Adjuvant Chemo-Radiotherapy
abstract	Purpose The benefit of neoadjuvant therapy for tumours above the peritoneal reflection is not clear. The purpose of this study is to demonstrate the feasibility and downstaging of treating locally advanced tumours from high rectum to distal sigmoid with preoperative chemoradiotherapy (CRT). Methods and Materials Seventeen patients with high rectal, recto-sigmoid or distal sigmoid tumours above the peritoneal reflection received neo-adjuvant CRT, selected on MRI findings indicating T4 disease or threatened circumferential resection margin. All patients were administered neoadjuvant chemotherapy, with Oxaliplatin or Mitomycin C and a Fluoropyrimidine. The pelvis received long-course CT-planned conformal RT, 45 Gy in 25 fractions, with a boost of 5.4–9 Gy in 3–5 fractions. Thirteen patients were treated with concomitant oral or intravenous Fluoropyrimidine chemotherapy. Results Median follow-up was 37 months. Overall survival was 82.35% (95% Confidence Interval (CI) 54.7–93.9) and disease free survival 81.25% (95% CI 52.5–93.5). Only 1 patient suffered loco-regional relapse. Chemotherapy regimens were well tolerated, though some patients required dose reductions. Nine patients (52.9%) lowered pathologic disease AJCC stage, i.e. ‘downstaged’. Six patients (35.3%) achieved complete pathological response. Clear margins were attained in all but 1 patient. Three patients were converted from cT4 to ypT3. No patient required a gap during CRT. One patient suffered a grade III acute toxicity, but no grade IV (RTOG). There were 3 grade III and 3 grade IV late toxicities (LENT-SOMA). Conclusions Locally advanced high rectal and recto-sigmoid tumours may be treated with pre-operative CRT with acceptable toxicity, impressive down-staging, and clear surgical margins.
abstractGer	Purpose The benefit of neoadjuvant therapy for tumours above the peritoneal reflection is not clear. The purpose of this study is to demonstrate the feasibility and downstaging of treating locally advanced tumours from high rectum to distal sigmoid with preoperative chemoradiotherapy (CRT). Methods and Materials Seventeen patients with high rectal, recto-sigmoid or distal sigmoid tumours above the peritoneal reflection received neo-adjuvant CRT, selected on MRI findings indicating T4 disease or threatened circumferential resection margin. All patients were administered neoadjuvant chemotherapy, with Oxaliplatin or Mitomycin C and a Fluoropyrimidine. The pelvis received long-course CT-planned conformal RT, 45 Gy in 25 fractions, with a boost of 5.4–9 Gy in 3–5 fractions. Thirteen patients were treated with concomitant oral or intravenous Fluoropyrimidine chemotherapy. Results Median follow-up was 37 months. Overall survival was 82.35% (95% Confidence Interval (CI) 54.7–93.9) and disease free survival 81.25% (95% CI 52.5–93.5). Only 1 patient suffered loco-regional relapse. Chemotherapy regimens were well tolerated, though some patients required dose reductions. Nine patients (52.9%) lowered pathologic disease AJCC stage, i.e. ‘downstaged’. Six patients (35.3%) achieved complete pathological response. Clear margins were attained in all but 1 patient. Three patients were converted from cT4 to ypT3. No patient required a gap during CRT. One patient suffered a grade III acute toxicity, but no grade IV (RTOG). There were 3 grade III and 3 grade IV late toxicities (LENT-SOMA). Conclusions Locally advanced high rectal and recto-sigmoid tumours may be treated with pre-operative CRT with acceptable toxicity, impressive down-staging, and clear surgical margins.
abstract_unstemmed	Purpose The benefit of neoadjuvant therapy for tumours above the peritoneal reflection is not clear. The purpose of this study is to demonstrate the feasibility and downstaging of treating locally advanced tumours from high rectum to distal sigmoid with preoperative chemoradiotherapy (CRT). Methods and Materials Seventeen patients with high rectal, recto-sigmoid or distal sigmoid tumours above the peritoneal reflection received neo-adjuvant CRT, selected on MRI findings indicating T4 disease or threatened circumferential resection margin. All patients were administered neoadjuvant chemotherapy, with Oxaliplatin or Mitomycin C and a Fluoropyrimidine. The pelvis received long-course CT-planned conformal RT, 45 Gy in 25 fractions, with a boost of 5.4–9 Gy in 3–5 fractions. Thirteen patients were treated with concomitant oral or intravenous Fluoropyrimidine chemotherapy. Results Median follow-up was 37 months. Overall survival was 82.35% (95% Confidence Interval (CI) 54.7–93.9) and disease free survival 81.25% (95% CI 52.5–93.5). Only 1 patient suffered loco-regional relapse. Chemotherapy regimens were well tolerated, though some patients required dose reductions. Nine patients (52.9%) lowered pathologic disease AJCC stage, i.e. ‘downstaged’. Six patients (35.3%) achieved complete pathological response. Clear margins were attained in all but 1 patient. Three patients were converted from cT4 to ypT3. No patient required a gap during CRT. One patient suffered a grade III acute toxicity, but no grade IV (RTOG). There were 3 grade III and 3 grade IV late toxicities (LENT-SOMA). Conclusions Locally advanced high rectal and recto-sigmoid tumours may be treated with pre-operative CRT with acceptable toxicity, impressive down-staging, and clear surgical margins.
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title_short	Successful Downstaging of High Rectal and Recto-Sigmoid Cancer by Neo-Adjuvant Chemo-Radiotherapy
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up_date	2024-07-03T18:16:00.143Z
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