Post on 04-Jul-2015
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State of the Art Radiotherapy in the Treatment of Colorectal Cancer: What Exactly Do
They Do?
Andrew Pearce MSc MD FRCPCChief, Dept of Oncology, Health Sciences NorthAssistant Professor, Northern Ontario School of MedicineRadiation Oncologist, Northeast Cancer Centre, HSN / ADCP
• 1168 pts 1987 – 1990
• 25Gy / 5 treatments over 1 week
• Surgery within one week
• vs. Surgery alone
years
years
years
• Surgery alone 27% local recurrence
• Surgery + RT 11% local recurrence
• 5 yr OS Surgery alone 48%
• 5 yr OS Surgery + RT 58%
• 1861 pts
• 25Gy / 5 treatments over 1 week - Surgery (TME)
• Vs. TME alone
• 2yr LR w TME alone 8.2%
• 2yr LR w RT and TME 2.4%
• At 5 yrs 10.9 vs. 5.6%
• T3 or T4 or node +v3
• inferior margin within 16cm of anal verge
• Preop chemorads vs post op chemo rads
• TME in all cases
• 5FU 1000mg/m2/day X 120 hours
• RT 5040 cGy (plus 540 cGY boost in post op)
• 4 Cycles of 5FU outback
• 823 pts from 26 hospitals
• Cases where surgeon did not feel sphincter could be spared:
• Pre op – did spare 39%
• Post op – did spare 19%
Preop chemo rads:
• Improves local control
• Improves sphincter preservation
• Better tolerated than post op
• No diff in DM or OS
• Preop CRT is the standard of care
• 25Gy / 5 days versus 50.5 Gy in 5 wks w chemo
• 326 pts
• 3yr LR
• Non-sig trend towards worse LC with short course
•Long Course CRT continues to be the standard of care
• Consider in metastatic setting
• Selected upper rectal cases
• Chemo RT for six weeks pre op is standard of care
•Modern Radiotherapy combines:
• Multiple diagnostic imaging modalities
• Standardized targeting
• Advanced computerized planning
• Intensity Modulated Delivery
• On board imaging verification
State of the Art Radiotherapy in the Treatment of Colorectal Cancer: What Exactly Do
They Do?
Andrew Pearce MSc MD FRCPCChief, Dept of Oncology, Health Sciences NorthAssistant Professor, Northern Ontario School of MedicineRadiation Oncologist, Northeast Cancer Centre, HSN / ADCP