Journal ArticleDOI
Impaired postoperative leucocyte counts after preoperative radiotherapy for rectal cancer in the Stockholm III Trial.
David Pettersson,Bengt Glimelius,Bengt Glimelius,H. Iversen,Hemming Johansson,Torbjörn Holm,Anna Martling +6 more
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TLDR
Differences between the randomization arms regarding leucocyte response and postoperative complications in rectal cancer patients were examined.Abstract:
Background
Radiotherapy (RT) in rectal cancer increases postoperative morbidity. A suggested reason is RT-induced bone marrow depression resulting in impaired leucocyte counts. The ongoing Stockholm III Trial randomizes patients with operable rectal cancers to short-course RT with immediate surgery (SRT), short-course RT with surgery delayed for 4–8 weeks (SRT-delay) and long-course RT with surgery delayed for 4–8 weeks (LRT-delay). This study examined differences between the randomization arms regarding leucocyte response and postoperative complications.
Methods
Patients randomized in the Stockholm III Trial between October 1998 and November 2010 were included. Data were collected in a prospective register. Additional data were obtained by retrospective review of clinical records.
Results
Of 657 randomized patients, 585 had data on leucocytes. The SRT arm had the highest proportion of postoperative complications (SRT, 52·5 per cent; SRT-delay, 39·4 per cent; LRT-delay, 41 per cent; P = 0·010). There was no association between low preoperative leucocyte count and postoperative complications (P = 0·238). Irrespective of randomization arm, patients with an impaired postoperative to preoperative leucocyte ratio had the highest rate of complications (low ratio, 56·6 per cent; intermediate ratio, 46·9 per cent; high ratio, 36·3 per cent; P = 0·010). The SRT arm had the highest proportion of low ratios (SRT, 48·9 per cent; SRT-delay, 22·8 per cent; LRT-delay, 22 per cent; P < 0·001).
Conclusion
An impaired postoperative leucocyte response is associated with postoperative complications. The highest risk is with immediate surgery following short-course radiotherapy. Registration number: NCT 00904813 (http://www.clinicaltrials.gov).read more
Citations
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EURECCA colorectal: Multidisciplinary management: European consensus conference colon & rectum
Cornelis J.H. van de Velde,Petra G. Boelens,Josep M. Borràs,Jan Willem Coebergh,Andrés Cervantes,Lennart Blomqvist,Regina G. H. Beets-Tan,Colette B.M. van den Broek,Gina Brown,Eric Van Cutsem,Eloy Espin,Karin Haustermans,Bengt Glimelius,Lene Hjerrild Iversen,J. Han van Krieken,Corrie A.M. Marijnen,Geoffrey Henning,Jola Gore-Booth,E. Meldolesi,Pawel Mroczkowski,Iris D. Nagtegaal,Peter Naredi,H. Ortiz,Lars Påhlman,Philip Quirke,Claus Rödel,Arnaud Roth,Harm J. T. Rutten,Hans J. Schmoll,J. J. Smith,Pieter J. Tanis,Claire Taylor,A. Wibe,Theo Wiggers,Maria Antonietta Gambacorta,Cynthia Aristei,Vincenzo Valentini +36 more
TL;DR: The first multidisciplinary consensus conference about cancer of the colon and rectum was held in December 2012 as mentioned in this paper, where the expert panel consisted of representatives of European scientific organisations involved in cancer care of patients with colon and Rectal cancer and representatives of national colorectal registries.
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References
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Journal ArticleDOI
Adjuvant radiotherapy for rectal cancer: a systematic overview of 8,507 patients from 22 randomised trials
Richard Gray,Robert Kerrin Hills,Rebecca Stowe,Mike Clarke,Richard Peto,Marc Buyse,P. Piedbois +6 more
TL;DR: Overall survival would be moderately improved by use of preoperative radiotherapy, especially for young, high risk patients, and short preoperative radiation schedules seem to be at least as effective as longer schedules.
Journal Article
Adjuvant radiotherapy for rectal cancer: a systematic overview of 8507 patients from 22 randomised trials. Commentary
TL;DR: Preoperative radiotherapy (at biologically effective doses ≥30 Gy) reduces risk of local recurrence and death from rectal cancer, but short preoperative radiation schedules seem to be at least as effective as longer schedules.
Journal ArticleDOI
A systematic overview of radiation therapy effects in rectal cancer.
TL;DR: Peroperative radiotherapy, preferably preoperative since it is more effective, is routinely recommended for most patients with rectal cancer since it can substantially decrease the risk of a local failure and increases survival.
Journal ArticleDOI
Long-term results of a randomised trial of short-course low-dose adjuvant pre-operative radiotherapy for rectal cancer: Reduction in local treatment failure
TL;DR: Long-term survival was unaffected, but long-term local recurrence was reduced by the addition of low-dose radiotherapy to surgery, and peri-operative mortality was, however, increased.
Journal ArticleDOI
Interim analysis of the Stockholm III trial of preoperative radiotherapy regimens for rectal cancer
David Pettersson,Björn Cedermark,Torbjörn Holm,Calin Radu,Lars Påhlman,Bengt Glimelius,Anna Martling +6 more
TL;DR: The present interim analysis assessed feasibility, compliance and complications after RT and surgery, and randomized patients to preoperative short‐course RT with two different intervals to surgery, or long‐ Course RT with delayed surgery.