Loading
The British trial that settled the timing question: giving everyone a short course of radiotherapy before surgery beats operating first and irradiating only those whose margins turn out to be involved.
Sebag-Montefiore, Stephens, Steele and colleagues randomised 1,350 patients with operable rectal adenocarcinoma in 80 centres in four countries to short-course preoperative radiotherapy (25 Gy in five fractions, 674 patients) or to initial surgery with selective postoperative chemoradiotherapy (45 Gy in 25 fractions with concurrent fluorouracil) restricted to patients with an involved circumferential resection margin (676 patients). The primary outcome measure was local recurrence, analysed by intention to treat.
At analysis, 330 patients had died and median follow-up of survivors was four years; 99 patients had developed local recurrence.
The trial that made preoperative rather than postoperative radiotherapy the UK standard, and the one whose circumferential resection margin pathology protocol, led by Quirke, became the quality measure for rectal surgery worldwide.
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.
The single largest improvement in rectal cancer outcomes came from a change in surgical technique, not a drug. Every radiotherapy trial since has had to show it adds something on top of a properly performed total mesorectal excision.
Shares Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer (Dutch TME trial), Total mesorectal excision (TME), Radiotherapy, Surgery and radiotherapy cure most, get least and the tag colorectal-evidence.
Shares Total mesorectal excision (TME), Radiotherapy, Chemoradiation (chemoradiotherapy, CRT), Surgery and radiotherapy cure most, get least and the tag colorectal-evidence.
Shares Total mesorectal excision (TME), Radiotherapy, Chemoradiation (chemoradiotherapy, CRT), IMRT / IGRT (modern external beam) and the tag colorectal-evidence.
Shares Total mesorectal excision (TME), Radiotherapy, Chemoradiation (chemoradiotherapy, CRT), Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation and the tag colorectal-evidence.
Shares Radiotherapy, Chemoradiation (chemoradiotherapy, CRT), Surgery and radiotherapy cure most, get least, Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation and the tag colorectal-evidence.
Shares Total mesorectal excision (TME), Radiotherapy, Surgery and radiotherapy cure most, get least, Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation and the tag colorectal-evidence.
Shares Surgery and radiotherapy cure most, get least, Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation, Fluorouracil (5-FU), Colorectal cancer and the tag colorectal-evidence.
Shares Total mesorectal excision (TME), Radiotherapy, Surgery and radiotherapy cure most, get least, Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation and the tag colorectal-evidence.