This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Gerard, J.-P. Articles by Adeleine, P. Search for Related Content PubMed PubMed Citation Articles by Gerard, J.-P. Articles by Adeleine, P. Social Bookmarking                            What's this?

Improved Sphincter Preservation in Low Rectal Cancer With High-Dose Preoperative Radiotherapy: The Lyon R96-02 Randomized Trial

From the Department of Radiotherapy, Centre Antoine-Lacassagne, Nice; Department of Radiotherapy and Department of General Surgery CHU Lyon Sud, Pierre Bênite; Department of Biostatistics, Department of General Surgery, Hôpital Croix Rousse, Hôpital Edouard Herriot, CHU Lyon, and Clinique Charcot, Sainte Foy, Lyon; Clinique Saint-Jean, Lyon; Clinique Denis, MÂcon; Department of Radiotherapy, Centre George-François Leclerc, Dijon; Department of Radiotherapy, Centre René Gauducheau, Nantes; Clinique Trenel, Vienne; Clinique Sainte Marie-Thérèse, Bron, France

Address reprint requests to Jean-Pierre Gérard, MD, Centre Antoine-Lacassagne, 33 Avenue de Valombrose, 06189 Nice Cedex 2, France; e-mail: jean-pierre.gerard{at}cal.nice.fnclcc.fr

PURPOSE: The potential advantage of high-dose preoperative radiotherapy to increase tumor response and improve the chance of sphincter preservation for low rectal cancer remains controversial. The aim of this trial was to evaluate the role of escalating the dose of preoperative radiation to increase sphincter-saving procedures.

PATIENTS AND METHODS: Patients with rectal carcinoma located in the lower rectum, staged T2 or T3, Nx, or M0 with endorectal sonography, and not involving more than two-thirds circumference, were randomly assigned to one of two groups: preoperative external-beam radiotherapy (EBRT; 39 Gy in 13 fractions over 17 days) versus the same EBRT with boost (85 Gy in three fractions) using endocavitary contact x-ray.

RESULTS: Between 1996 and 2001, 88 patients were enrolled onto the study. A significant improvement was seen in favor of the contact x-ray boost for complete clinical response (24% v 2%) and for a complete or near-complete sterilization of the operative specimen (57% v 34%). A significant increase in sphincter preservation was observed in the boost group (76% v 44%; P = .004). At a median follow-up of 35 months, there was no difference in morbidity, local relapse, and 2-year overall survival.

CONCLUSION: A dose escalation with endocavitary irradiation provides increased tumor response and sphincter preservation with no detrimental effect on treatment toxicity and early clinical outcome.

Presented at the 45^th Annual Meeting of the American Society of Therapeutic Radiology and Oncology, Salt Lake City, UT, October 21, 2003.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				B D P O'NEILL, G SALERNO, K THOMAS, D M TAIT, and G BROWN MR vs CT imaging: low rectal cancer tumour delineation for three-dimensional conformal radiotherapy Br. J. Radiol., June 1, 2009; 82(978): 509 - 513. [Abstract] [Full Text] [PDF]

				J Murphy, D Boyle, C Bhan, and N S Williams Letter in response to 'Unacceptable variation in abdominoperineal excision rates for rectal cancer: time to intervene?' Gut, January 1, 2009; 58(1): 146 - 146. [Full Text] [PDF]

				B. S. Min, Y. J. Choi, H. R. Pyo, H. Kim, J. Seong, H. C. Chung, S. Y. Rha, and N. K. Kim Cyclooxygenase-2 Expression in Pretreatment Biopsy as a Predictor of Tumor Responses After Preoperative Chemoradiation in Rectal Cancer Arch Surg, November 1, 2008; 143(11): 1091 - 1097. [Abstract] [Full Text] [PDF]

				R. Glynne-Jones and M. Harrison Locally Advanced Rectal Cancer: What Is the Evidence for Induction Chemoradiation? Oncologist, November 1, 2007; 12(11): 1309 - 1318. [Abstract] [Full Text] [PDF]

				J.-P. Gerard, T. Conroy, F. Bonnetain, O. Bouche, O. Chapet, M.-T. Closon-Dejardin, M. Untereiner, B. Leduc, E. Francois, J. Maurel, et al. Preoperative Radiotherapy With or Without Concurrent Fluorouracil and Leucovorin in T3-4 Rectal Cancers: Results of FFCD 9203 J. Clin. Oncol., October 1, 2006; 24(28): 4620 - 4625. [Abstract] [Full Text] [PDF]

				F. A. Calvo, F. J. Serrano, J. A. Diaz-Gonzalez, M. Gomez-Espi, E. Lozano, R. Garcia, D. de la Mata, J. A. Arranz, P. Garcia-Alfonso, G. Perez-Manga, et al. Improved incidence of pT0 downstaged surgical specimens in locally advanced rectal cancer (LARC) treated with induction oxaliplatin plus 5-fluorouracil and preoperative chemoradiation Ann. Onc., July 1, 2006; 17(7): 1103 - 1110. [Abstract] [Full Text] [PDF]

				R. Rengan, P. Paty, W. D. Wong, J. Guillem, M. Weiser, L. Temple, L. Saltz, and B. D. Minsky Distal cT2N0 Rectal Cancer: Is There an Alternative to Abdominoperineal Resection? J. Clin. Oncol., August 1, 2005; 23(22): 4905 - 4912. [Abstract] [Full Text] [PDF]

				I. Zlobec, R. Steele, N. Nigam, and C. C. Compton A Predictive Model of Rectal Tumor Response to Preoperative Radiotherapy Using Classification and Regression Tree Methods Clin. Cancer Res., August 1, 2005; 11(15): 5440 - 5443. [Abstract] [Full Text] [PDF]

				C. A.M. Marijnen, C. J.H. van de Velde, H. Putter, M. van den Brink, C. P. Maas, H. Martijn, H. J. Rutten, T. Wiggers, E. K. Kranenbarg, J.-W. H. Leer, et al. Impact of Short-Term Preoperative Radiotherapy on Health-Related Quality of Life and Sexual Functioning in Primary Rectal Cancer: Report of a Multicenter Randomized Trial J. Clin. Oncol., March 20, 2005; 23(9): 1847 - 1858. [Abstract] [Full Text] [PDF]