Rectal Cancer - Radiotherapy

Swedish study:

  • Overall and cause specific survival improved
  • Local recurrence significantly improved
  • Late effects - doubling of small bowel obstruction

Dutch Study:

  • TME alone - 8% recurrence
  • TME + Neo-Adj RT - 2.5% recurrence
  • Late effects - worse incontinence (50 vs 35%), worse function
  • Better QOL with stoma than anastamosis (74% satisfied vs 54%)

Sauer:

  • Neoadjuvant RT vs Adjuvant
    • No change in survival
    • Better local control (6% vs 13%)
    • Toxicity better (23% vs 40%)

Polish Study:

  • No difference in sphincter preservation between short/long course

Gerard:

  • Chemotherapy (5FU bolus) + RT (45/25) vs RT alone (45/25)
  • No change overall / cause specific survival
  • Improved local control (16% vs 8%)
  • No change in sphincter preservation

O'Conner

  • Adjuvant chemotherapy - bolus vs infusional 5FU, carmustine yes vs no
  • 70% vs 60% (infusional vs bolus)
  • Infusional also showed reduction in distant metastases
  • Local recurrence not significantly impacted
  • Increased diarrhoea with infusional

Bose:

  • CT improved local control compared with no CT
  • no change in OS

Radiotherapy is typically used for locally advanced rectal cancer.

Early stage

Rectal cancer that does not penetrate the muscularis propria of the rectum is unlikely to recur locally if a mesorectal excision is performed at surgery. Radiotherapy has no role to play in this scenario.

Locally Advanced

Locally advanced disease invades through the muscularis (T3) and/or into adjacent organs (T4).

Dose

45 Gy to pelvis - including internal iliac, presacral nodes
If 2 phase - 5.4 Gy - 9 Gy boost to mesorectum

Obstruction
- defunction colostomy if present

Pmhx
- Cardio
- Gut
- rt

Exam
- general

  • abdo
  • pr
  • pv!

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Ix

  • bloods (CEA)
  • colonoscopy - distance,

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