In a literature-based meta-analysis, the survival data of 1927 patients from 32 eligible publications were analysed.
The calculated survival rates of documented patients show remarkably good results with preoperative CRT and radical surgery. However, the findings of this analysis are based on data with a large proportion of studies using consecutive patient series.
Hard evidence providing sufficient data from prospective randomised studies is as yet missing for preoperative CRT. Prospective randomised studies are mandatory in this area.
Purchase PDF (715 K) | Comparison of 5 International Journal of Radiation Oncology*Biology*Phy... |
  Comparison of 5International Journal of Radiation Oncology*Biology*Physics, Volume 67, Issue 2, 1 February 2007, Pages 378-384 Dae Yong Kim, Kyung Hae Jung, Tae Hyun Kim, Duck-Woo Kim, Hee Jin Chang, Jun Yong Jeong, Young Hoon Kim, Seok-Hyun Son, Tak Yun, Chang Won Hong, Dae Kyung Sohn, Seok-Byung Lim, Hyo Seong Choi, Seung-Yong Jeong, Jae-Gahb Park Abstract Purpose: To describe our experience with a bolus injection of 5-fluorouracil and leucovorin (FL) vs. capecitabine in terms of radiologic and pathologic findings in preoperative chemoradiotherapy (CRT) for locally advanced rectal cancer. Methods: The study enrolled 278 patients scheduled for preoperative CRT using two protocols with different chemotherapeutic regimens. Pelvic radiotherapy (50.4 Gy) was delivered concurrently with FL (n = 145) or capecitabine (n = 133). Surgery was performed 6 weeks after CRT completion. Tumor responses to CRT were measured using both radiologic and pathologic examination. Magnetic resonance volumetry was performed at the initial workup and just before surgery after completion of preoperative CRT. Post-CRT pathology tests were used to determine tumor stage and regression. Results: Radiologic examination showed that tumor volume decreased by 68.2%± 20.5%in the FL group and 68.3%± 22.3%in the capecitabine group (p = 0.970). Postoperative pathologic T stage determination showed that downstaging occurred in 44.3%of FL and 49.9%of capecitabine patients (p = 0.571). The tumor regression grades after CRT were Grade 1 (minimal response) in 22.6%and 21.0%, Grade 2 (moderate response) in 53.2%and 50.0%, Grade 3 (near-complete response) in 12.9%and 12.9%, and Grade 4 (complete response) in 11.3%and 16.1%of the FL and capecitabine groups, respectively (p = 0.758). Conclusion: In the present study, the radiologic and pathologic findings did not reveal significant differences in short-term tumor responses between preoperative FL and capecitabine CRT for locally advanced rectal cancer. Long-term results and a prospective randomized trial are needed. Purchase PDF (102 K) |
| Prediction of rectal lymph node metastasis by pelvic co... European Journal of Surgical Oncology (EJSO) |
| Prediction of rectal lymph node metastasis by pelvic computed tomography measurement European Journal of Surgical Oncology (EJSO), In Press, Corrected Proof, Available online 24 March 2008 F. Pomerri, I. Maretto, S. Pucciarelli, M. Rugge, S. Burzi, M. Zandonà, A. Ambrosi, E. Urso, P.C. Muzzio, D. Nitti Abstract AimRectal cancer staging represents a crucial step to select the best treatment for this tumour. Particularly after neo-adjuvant chemoradiotherapy (CRT), it may influence the surgical procedure (e.g. radical resection vs. local excision). The aim of this study was to determine the best lymph node size cut-off at computed tomography (CT) to predict nodal metastasis in rectal cancer patients with and without preoperative CRT.MethodsA consecutive series of patients operated on for primary mid–low rectal adenocarcinoma, all staged with pelvic CT scan, were subdivided as follows: those who underwent surgery alone treatment without CRT (Group A) and those who underwent preoperative CRT (Group B). All CT scans were re-viewed by a single radiologist and, based on the lymph node size, findings were compared with pathologic lymph node status (pN). At each lymph node size cut-off value, the following were calculated: accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). The best cut-off value was defined as having an accuracy ≥70%with the highest NPV. ResultsThe study population consisted of 162 patients: Group A (n = 52) and Group B (n = 110). Patients classified as pN-positive (n = 45) had a higher number of and larger sized lymph nodes by CT scan than patients classified as pN-negative (n = 117). The cut-off values with an accuracy ≥70%ranged between 7 and 11 mm in Group A and between 9 and 14 mm in Group B. The cut-off with the best NPV was 7 mm for Group A and 10 mm for Group B. ConclusionsAcknowledging the limitations of the dimensional criterion, lymph node size cut-off values found in our study may be useful for planning rectal cancer treatment using CT scan. Purchase PDF (166 K) |
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doi:10.1016/j.ijrobp.2007.10.009 
Treatment Outcome and Recursive Partitioning Analysis-Based Prognostic Factors in Patients With Esophageal Squamous Cell Carcinoma Receiving Preoperative Chemoradiotherapy
