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

http://www.ro-journal.com/content/5/1/17/figure/F2

• 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