- •Among academic radiation oncologists, medical oncologists, and colorectal surgeons, the traditional regimen of long-course chemoradiation, surgery, and adjuvant chemotherapy is now infrequently recommended for locally advanced rectal cancer.
- •Total neoadjuvant therapy has been widely adopted for locally advanced node positive rectal tumors with variable patterns of care with respect to sequencing of chemotherapy and radiotherapy.
- •Fractionation with long-course chemoradiation remains the majority; however, short-course radiotherapy is gaining acceptance, notably for mid- and upper rectal tumors.
- •Non-operative management after a clinical complete response in low rectal tumors has gained traction, transforming locally advanced rectal cancer from a once classically perceived surgical disease.
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
USCS Data Visualizations. Accessed May 2, 2021. https://gis.cdc.gov/grasp/USCS/DataViz.html
- Preoperative Versus Postoperative Chemoradiotherapy for Locally Advanced Rectal Cancer: Results of the German CAO/ARO/AIO-94 Randomized Phase III Trial After a Median Follow-Up of 11 Years.J Clin Oncol. 2012; 30: 1926-1933https://doi.org/10.1200/JCO.2011.40.1836
- Improved survival with preoperative radiotherapy in resectable rectal cancer.N Engl J Med. 1997; 336: 980-987https://doi.org/10.1056/NEJM199704033361402
- Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial.Lancet Oncol. 2011; 12: 575-582https://doi.org/10.1016/S1470-2045(11)70097-3
- Randomized trial of short-course radiotherapy versus long-course chemoradiation comparing rates of local recurrence in patients with T3 rectal cancer: Trans-Tasman Radiation Oncology Group trial 01.04.J Clin Oncol Off J Am Soc Clin Oncol. 2012; 30: 3827-3833https://doi.org/10.1200/JCO.2012.42.9597
- Interim analysis of the Stockholm III trial of preoperative radiotherapy regimens for rectal cancer.Br J Surg. 2010; 97: 580-587https://doi.org/10.1002/bjs.6914
- Total neoadjuvant therapy for rectal cancer: An emerging option.Cancer. 2017; 123: 1497-1506https://doi.org/10.1002/cncr.30600
- Watchful Waiting after Clinical Complete Response to Neoadjuvant Chemoradiation for Rectal Cancer.Int J Radiat Oncol Biol Phys. 2019; 105: E161https://doi.org/10.1016/j.ijrobp.2019.06.2133
- Preliminary results of the organ preservation of rectal adenocarcinoma (OPRA) trial.| Journal of Clinical Oncology. 2021; (Accessed May 2)
- Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial.Lancet Oncol. 2021; 22: 29-42https://doi.org/10.1016/S1470-2045(20)30555-6
rectal.pdf. Accessed November 21, 2021. https://www.nccn.org/professionals/physician_gls/pdf/rectal.pdf
- R: A language and environment for statistical ## computing.R Foundation for Statistical Computing, Vienna, Austria2019 (URL)
- Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER-PRODIGE 23): a multicentre, randomised, open-label, phase 3 trial.Lancet Oncol. 2021; 22: 702-715https://doi.org/10.1016/S1470-2045(21)00079-6
- Adoption of Total Neoadjuvant Therapy for Locally Advanced Rectal Cancer.JAMA Oncol. 2018; 4e180071https://doi.org/10.1001/jamaoncol.2018.0071
- Randomized Phase II Trial of Chemoradiotherapy Plus Induction or Consolidation Chemotherapy as Total Neoadjuvant Therapy for Locally Advanced Rectal Cancer: CAO/ARO/AIO-12.J Clin Oncol Off J Am Soc Clin Oncol. 2019; 37: 3212-3222https://doi.org/10.1200/JCO.19.00308
- INTACT TUMOR CELLS IN IRRADIATED TISSUE.Arch Pathol. 1964; 78: 648-651
- Cost-effectiveness of Short-Course Radiation Therapy vs Long-Course Chemoradiation for Locally Advanced Rectal Cancer.JAMA Netw Open. 2019; 2e192249https://doi.org/10.1001/jamanetworkopen.2019.2249
- The Financial Impact of Fractionation Scheme and Treatment Planning Method for Rectal Cancer in the United States.Clin Colorectal Cancer. 2019; 18: 209-217https://doi.org/10.1016/j.clcc.2019.05.005
- Preoperative radiotherapy 5 × 5 Gy and short versus long interval between surgery for resectable rectal cancer: 10-Year follow-up of the randomised controlled trial.Radiother Oncol. 2021; 164: 268-274https://doi.org/10.1016/j.radonc.2021.10.006
- Long-course oxaliplatin-based preoperative chemoradiation versus 5 × 5 Gy and consolidation chemotherapy for cT4 or fixed cT3 rectal cancer: results of a randomized phase III study.Ann Oncol Off J Eur Soc Med Oncol. 2016; 27: 834-842https://doi.org/10.1093/annonc/mdw062
- Utilization of short-course radiation therapy for patients with nonmetastatic rectal adenocarcinoma in the United States.Adv Radiat Oncol. 2018; 3: 611-620https://doi.org/10.1016/j.adro.2018.07.007
- Neoadjuvant long-course chemoradiation remains strongly favored over short-course radiotherapy by radiation oncologists in the United States.Cancer. 2017; 123: 1434-1441https://doi.org/10.1002/cncr.30461
- Short-Course Vs Long-Course Radiotherapy: Pros and Cons.in: Schlachta CM Sylla P Current Common Dilemmas in Colorectal Surgery. Springer International Publishing, 2018: 329-339https://doi.org/10.1007/978-3-319-70117-2_29
- Healthcare Cost Analysis of Short-Course vs. Long-Course Pre-Operative Radiotherapy Schedules for Rectal Cancer.Int J Radiat Oncol Biol Phys. 2021; 111: e341https://doi.org/10.1016/j.ijrobp.2021.07.1031
- Management of Locally Advanced Rectal Cancer During The COVID-19 Pandemic: A Necessary Paradigm Change at Memorial Sloan Kettering Cancer Center.Adv Radiat Oncol. 2020; 5: 687-689https://doi.org/10.1016/j.adro.2020.04.011
- Long-term Outcome of an Organ Preservation Program After Neoadjuvant Treatment for Rectal Cancer.J Natl Cancer Inst. 2016; 108https://doi.org/10.1093/jnci/djw171
- High-dose chemoradiotherapy and watchful waiting for distal rectal cancer: a prospective observational study.Lancet Oncol. 2015; 16: 919-927https://doi.org/10.1016/S1470-2045(15)00120-5
Alliance for Clinical Trials in Oncology. A Phase II/III Trial of Neoadjuvant FOLFOX With Selective Use of Combined Modality Chemoradiation Versus Preoperative Combined Modality Chemoradiation for Locally Advanced Rectal Cancer Patients Undergoing Low Anterior Resection With Total Mesorectal Excision (PROSPECT). clinicaltrials.gov; 2020. Accessed April 29, 2021. https://clinicaltrials.gov/ct2/show/NCT01515787
- Nonoperative Rectal Cancer Management With Short-Course Radiation Followed by Chemotherapy: A Nonrandomized Control Trial.Clin Colorectal Cancer. 2021; 20: e185-e193https://doi.org/10.1016/j.clcc.2021.03.003
- Clinical Complete Response in Patients With Rectal Adenocarcinoma Treated With Short-Course Radiation Therapy and Nonoperative Management.Int J Radiat Oncol. 2021; 12 (Published online October)https://doi.org/10.1016/j.ijrobp.2021.10.004
Rödel PD med C. Short-Course Radiotherapy Versus Chemoradiotherapy, Followed by Consolidation Chemotherapy, and Selective Organ Preservation for MRI-Defined Intermediate and High-Risk Rectal Cancer Patients. clinicaltrials.gov; 2021. Accessed January 27, 2022. https://clinicaltrials.gov/ct2/show/NCT04246684
University of Birmingham. STAR-TREC:Can the Rectum Be Saved by Watchful Waiting or TransAnal Surgery Following (Chemo)Radiotherapy Versus Total Mesorectal Excision for Early REctal Cancer. clinicaltrials.gov; 2018. Accessed January 27, 2022. https://clinicaltrials.gov/ct2/show/NCT02945566
- Good practice in the conduct and reporting of survey research.Int J Qual Health Care. 2003; 15: 261-266https://doi.org/10.1093/intqhc/mzg031
Publication stageIn Press Journal Pre-Proof
Funding: This work was supported by the STOP Cancer Award.