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Evidence summaries

Pre-Operative Radiotherapy (Prt) and Curative Surgery for Localized Rectal Carcinoma

Pre-operative radiotherapy appears to provide modest improvement in overall survival, definite improvement in local recurrences, modest increase in the proportion of patients undergoing curative surgery, but is also accompanied by an increase in acute and late rectal and sexual dysfunction compared with surgery alone. Level of evidence: "B"

A Cochrane review [Abstract] 1 included 19 studies. Overall (OA) mortality was marginally improved by PRT, HR 0.93 [95% CI -0.87-1](absolute difference is 2% if the expected survival rate is 60%). Local recurrence (LR) was improved but the magnitude of benefit was heterogeneous across trials. Sensitivity analyses suggested greater benefits in patients treated with BED>30Gy10 and multiple field RT techniques. There was significantly more pelvic or perineal wound infection, late rectal and sexual dysfunction.

Nine trials compared PRT vs. other NA/A. Available evidence did not support an OA mortality or sphincter preserving benefit with the use of combined chemoradiotherapy (CRT) or selective postoperative RT. CRT provides incremental benefit for local control compared with PRT, which was independent of the timing of the CT. There was no significant difference in outcome for different intervals between RT and surgery (2 vs. 8 wk). Dose escalation with endocavitary boost showed significant effect on sphincter preservation.

Comment: The study quality is downgraded by indirectness; differences in studied interventions in time and in techniques.

    References

    • Wong RK, Tandan V, De Silva S, Figueredo A. Pre-operative radiotherapy and curative surgery for the management of localized rectal carcinoma. Cochrane Database Syst Rev 2007 Apr 18;(2):CD002102. [PubMed]

Primary/Secondary Keywords