PURPOSE:Total mesorectal excision (TME) surgery in the treatment of rectal cancer has been shown to result in a reduction in the number of local recurrences in retrospective studies. Reports on improved local control after preoperative, hypofractionated radiotherapy (RT) have led to the introduction of a prospective randomized multicenter trial, in which the effect of TME surgery with or without preoperative RT were evaluated. Any benefit in regard to a reduced local recurrence rate and possible improved survival must be weighed against potential adverse effects in both the short-term and the long-term. The present study was undertaken to assess the acute side effects of short-term, preoperative RT in rectal cancer patients and to study the influence of five doses of 5 Gy on surgical parameters, postoperative morbidity and mortality in patients randomized in the Dutch TME trial. PATIENTS AND METHODS: We analyzed 1,530 Dutch patients entered onto a prospective randomized trial, comparing preoperative RT with five doses of 5 Gy followed by TME surgery with TME surgery alone, of which 1,414 patients were assessable. Toxicity from RT, surgery characteristics, and postoperative complications and mortality were compared. RESULTS:Toxicity during RT hardly occurred. Irradiated patients had 100 mL more blood loss during the operation (P <.001) and showed more perineal complications (P =.008) in cases of abdominoperineal resection. The total number of complications was slightly increased in the irradiated group (P =.008). No difference was observed in postoperative mortality (4.0% v 3.3%) or in the number of reinterventions. CONCLUSION: Preoperative hypofractionated RT is a safe procedure in patients treated with TME surgery, despite a slight increase in complications when compared with TME surgery only.
RCT Entities:
PURPOSE: Total mesorectal excision (TME) surgery in the treatment of rectal cancer has been shown to result in a reduction in the number of local recurrences in retrospective studies. Reports on improved local control after preoperative, hypofractionated radiotherapy (RT) have led to the introduction of a prospective randomized multicenter trial, in which the effect of TME surgery with or without preoperative RT were evaluated. Any benefit in regard to a reduced local recurrence rate and possible improved survival must be weighed against potential adverse effects in both the short-term and the long-term. The present study was undertaken to assess the acute side effects of short-term, preoperative RT in rectal cancerpatients and to study the influence of five doses of 5 Gy on surgical parameters, postoperative morbidity and mortality in patients randomized in the Dutch TME trial. PATIENTS AND METHODS: We analyzed 1,530 Dutch patients entered onto a prospective randomized trial, comparing preoperative RT with five doses of 5 Gy followed by TME surgery with TME surgery alone, of which 1,414 patients were assessable. Toxicity from RT, surgery characteristics, and postoperative complications and mortality were compared. RESULTS:Toxicity during RT hardly occurred. Irradiated patients had 100 mL more blood loss during the operation (P <.001) and showed more perineal complications (P =.008) in cases of abdominoperineal resection. The total number of complications was slightly increased in the irradiated group (P =.008). No difference was observed in postoperative mortality (4.0% v 3.3%) or in the number of reinterventions. CONCLUSION: Preoperative hypofractionated RT is a safe procedure in patients treated with TME surgery, despite a slight increase in complications when compared with TME surgery only.
Authors: Ewelina Kluza; Esther D Rozeboom; Monique Maas; Milou Martens; Doenja M J Lambregts; Jos Slenter; Geerard L Beets; Regina G H Beets-Tan Journal: Eur Radiol Date: 2012-07-10 Impact factor: 5.315
Authors: G Rizzo; D P Pafundi; F Sionne; L D'Agostino; G Pietricola; M A Gambacorta; V Valentini; C Coco Journal: Tech Coloproctol Date: 2021-01-18 Impact factor: 3.781
Authors: Y L B Klaver; V E P P Lemmens; S W Nienhuijs; G A P Nieuwenhuijzen; H J T Rutten; I H J T de Hingh Journal: Strahlenther Onkol Date: 2013-01-19 Impact factor: 3.621
Authors: Marco E Allaix; Alberto Arezzo; Simone Arolfo; Mario Caldart; Fabrizio Rebecchi; Mario Morino Journal: J Gastrointest Surg Date: 2012-10-24 Impact factor: 3.452
Authors: J Gallego-Plazas; F Menárguez-Pina; A Maestre-Peiró; V González-Orozco; F Andreu; M J Escudero-Barea; M A Morcillo Journal: Clin Transl Oncol Date: 2009-03 Impact factor: 3.405