Sauer 2004: chemoradiotherapy before rather than after surgery for rectal cancer (CAO/ARO/AIO-94)
Giving chemotherapy and radiotherapy before surgery rather than after halved local recurrences of rectal cancer, caused less toxicity and let more patients keep their anal sphincter, without changing overall survival.
Overview
The German Rectal Cancer Study Group randomised 823 patients with locally advanced rectal cancer (clinical stage T3 or T4 or node-positive) to fluorouracil-based chemoradiotherapy either before or after total mesorectal excision, with both groups receiving further chemotherapy. Preoperative treatment reduced five-year local recurrence, lowered acute and long-term toxicity and increased sphincter-preserving surgery among patients whose tumours had been judged to need an abdominoperineal resection, while overall survival was the same in both arms.
- 823 patients with locally advanced rectal cancer; chemoradiotherapy before or after total mesorectal excision.
- Five-year local recurrence 6% with preoperative vs 13% with postoperative treatment.
- Five-year overall survival 76% vs 74%, not significantly different.
- Grade 3 or 4 acute toxicity 27% vs 40%; long-term toxicity 14% vs 24%; sphincter preservation rose in patients initially judged to need an abdominoperineal resection.
This trial made preoperative chemoradiotherapy the standard for locally advanced rectal cancer worldwide and is the foundation on which total neoadjuvant therapy and watch-and-wait organ preservation were later built.
- Overall survival was unchanged; the gain is in local control, toxicity and function.
- Chemotherapy was fluorouracil alone by the standards of 2004.
- Staging relied on endorectal ultrasound and CT rather than modern MRI.
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not linked directly; found by shared links- PersonAngelita Habr-Gama
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- TermTotal mesorectal excision (TME)
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- TermFOLFOX, FOLFIRI, FOLFIRINOX and CAPOX
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- TermLocally advanced and locoregional disease
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- TargetThymidylate synthase (TYMS)
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- TermAbdominoperineal resection
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Shares Fluorouracil (5-FU), Colorectal cancer.