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Reviewed by: Jack Wei, MD
The Abramson Cancer Center of the University of Pennsylvania
Ultima Vez Modificado: 10 de diciembre del 2004
Authors: Rolf Sauer MD, Heinz Becker MD, Werner Hohenberger MD, et al. for the German Rectal Cancer Study Group
Source: New England Journal of Medicine 351(17): 1731-1340 (2004)
The current study addresses an important question in the optimal treatment of rectal cancer. Previously, two studies in the United States attempted to address this exact issue; however, both were closed due to lack of patient accrual. This study shows that in patients who are judged to require postoperative CTRT by preoperative staging, the use of preoperative therapy results in improved local control and decreased rates of complications compared to postoperative therapy. This study utilized chemotherapy and radiation that is widely used in the United States and should be widely applicable to treatment of these patients.
Two important caveats should be considered when interpreting the results of this study. First, the study was not analyzed in an intent-to-treat manner. Instead, patients were allowed to switch treatment groups after being informed of the treatment arm to which they were randomized. The analysis was performed by the actual treatment received, rather than by the group to which they were randomized. This introduces a potential bias in the results as an uneven distribution of patients may switch from one group to the other. Second, almost one-fifth of patients in the postoperative CTRT group were found to have either stage I disease or distant metastatic disease at the time of surgery. This indicates that a similar percentage of patients underwent CTRT in the preoperative therapy arm that otherwise may not have if their pathologic stage had been available. The potential for overtreating a number of patients clearly exists when treating patients with preoperative CTRT. Despite this fact, the relatively low rates of complications with preoperative treatment, the improvement in sphincter-preservation in patients deemed to need an APR, and the improvement in local control would indicate that preoperative CTRT would be preferred in these patients, particularly for those with low-lying tumors who are at risk for requiring an APR.
Ms. Gambino talks about the complexity of cancer care and the need for patients and families to have help in navigating from diagnosis and treatment decisions to survivorship. Read more.
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