ACR Appropriateness Criteria® Resectable Rectal Cancer

Radiation Oncology

W Warren Suh¹  Jennifer Zook^1,10  William Small^1,16  Miguel Rodriguez-Bigas^1,15  Albert C Koong⁵  Andre A Konski^1,12  Salma K Jabbour^1,11  Theodore S Hong^1,13  Karyn A Goodman³  Prajnan Das^1,14  William Blackstock⁶  Nilofer Azad⁸  May Abdel-Wahab²  Joseph M Herman⁹  Charles R Thomas⁷  William E Jones⁴ 

[1] Cancer Center of Santa Barbara, Santa Barbara, California, USA;University of Miami, Miami, Florida, USA;Memorial Sloan-Kettering Cancer Center, New York, New York, USA;UT Health Science Center San Antonio, San Antonio, Texas, USA;Stanford University Medical Center, Stanford, California, USA;Wake Forest University, Winston Salem, North Carolina, USA;Knight Cancer Institute at Oregon Health and Science University, Portland, Oregon, US;Sidney Kimmel Cancer Center at Johns Hopkins, American Society of Clinical Oncology, Baltimore, Maryland, USA;Sidney Kimmel Cancer Center at Johns Hopkins, Baltimore, Maryland, USA;Indiana University School of Medicine, Indianapolis, Indiana, USA;Cancer Institute of New Jersey, University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey, USA;Wayne State University School of Medicine, Detroit, Michigan, USA;Massachusetts General Hospital, Boston, Massachusetts, USA;MD Anderson Cancer Center, Houston, Texas, USA;MD Anderson Cancer Center, American College of Surgeons, Houston, Texas, USA;The Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois, USA

关键词: Chemotherapy;    Radiotherapy;    Chemoradiotherapy;    Rectal cancer;    Appropriateness criteria;   

Others  :  1155269
DOI  :  10.1186/1748-717X-7-161

 received in 2012-08-28, accepted in 2012-09-09,  发布年份 2012

【 摘 要 】

The management of resectable rectal cancer continues to be guided by clinical trials and advances in technique. Although surgical advances including total mesorectal excision continue to decrease rates of local recurrence, the management of locally advanced disease (T3-T4 or N+) benefits from a multimodality approach including neoadjuvant concomitant chemotherapy and radiation. Circumferential resection margin, which can be determined preoperatively via MRI, is prognostic. Toxicity associated with radiation therapy is decreased by placing the patient in the prone position on a belly board, however for patients who cannot tolerate prone positioning, IMRT decreases the volume of normal tissue irradiated. The use of IMRT requires knowledge of the patterns of spreads and anatomy. Clinical trials demonstrate high variability in target delineation without specific guidance demonstrating the need for peer review and the use of a consensus atlas. Concomitant with radiation, fluorouracil based chemotherapy remains the standard, and although toxicity is decreased with continuous infusion fluorouracil, oral capecitabine is non-inferior to the continuous infusion regimen. Additional chemotherapeutic agents, including oxaliplatin, continue to be investigated, however currently should only be utilized on clinical trials as increased toxicity and no definitive benefit has been demonstrated in clinical trials.

The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

【 授权许可】

   
2012 Jones et al.; Copyright American College of Radiology.

【 参考文献 】

• [1]National Cancer Institute: Comprehensive Cancer Information. http://www.cancer.gov/cancertopics/types/colon-and-rectal webcite Accessed 5 January 2012
• [2]Rich T, Gunderson LL, Lew R, Galdibini JJ, Cohen AM, Donaldson G: Patterns of recurrence of rectal cancer after potentially curative surgery. Cancer 1983, 52(7):1317-1329.
• [3]Sauer R, Becker H, Hohenberger W, et al.: Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004, 351(17):1731-1740.
• [4]Bernstein TE, Endreseth BH, Romundstad P, Wibe A: Circumferential resection margin as a prognostic factor in rectal cancer. Br J Surg 2009, 96(11):1348-1357.
• [5]Tilney HS, Rasheed S, Northover JM, Tekkis PP: The influence of circumferential resection margins on long-term outcomes following rectal cancer surgery. Dis Colon Rectum 2009, 52(10):1723-1729.
• [6]Gosens MJ, Klaassen RA, Tan-Go I, et al.: Circumferential margin involvement is the crucial prognostic factor after multimodality treatment in patients with locally advanced rectal carcinoma. Clin Cancer Res 2007, 13(22 Pt 1):6617-6623.
• [7]Quirke P, Steele R, Monson J, et al.: Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. Lancet 2009, 373(9666):821-828.
• [8]Mohiuddin M, Winter K, Mitchell E, et al.: Randomized phase II study of neoadjuvant combined-modality chemoradiation for distal rectal cancer: Radiation Therapy Oncology Group Trial 0012. J Clin Oncol 2006, 24(4):650-655.
• [9]Krook JE, Moertel CG, Gunderson LL, et al.: Effective surgical adjuvant therapy for high-risk rectal carcinoma. N Engl J Med 1991, 324(11):709-715.
• [10]Thomas PR, Lindblad AS: Adjuvant postoperative radiotherapy and chemotherapy in rectal carcinoma: a review of the Gastrointestinal Tumor Study Group experience. Radiother Oncol 1988, 13(4):245-252.
• [11]Tveit KM, Guldvog I, Hagen S, et al.: Randomized controlled trial of postoperative radiotherapy and short-term time-scheduled 5-fluorouracil against surgery alone in the treatment of Dukes B and C rectal cancer. Norwegian Adjuvant Rectal Cancer Project Group. Br J Surg 1997, 84(8):1130-1135.
• [12]Fisher B, Wolmark N, Rockette H, et al.: Postoperative adjuvant chemotherapy or radiation therapy for rectal cancer: results from NSABP protocol R-01. J Natl Cancer Inst 1988, 80(1):21-29.
• [13]Wolmark N, Wieand HS, Hyams DM, et al.: Randomized trial of postoperative adjuvant chemotherapy with or without radiotherapy for carcinoma of the rectum: National Surgical Adjuvant Breast and Bowel Project Protocol R-02. J Natl Cancer Inst 2000, 92(5):388-396.
• [14]Smalley SR, Benedetti JK, Williamson SK, et al.: Phase III trial of fluorouracil-based chemotherapy regimens plus radiotherapy in postoperative adjuvant rectal cancer: GI INT 0144. J Clin Oncol 2006, 24(22):3542-3547.
• [15]O'Connell MJ, Martenson JA, Wieand HS, et al.: Improving adjuvant therapy for rectal cancer by combining protracted-infusion fluorouracil with radiation therapy after curative surgery. N Engl J Med 1994, 331(8):502-507.
• [16]Tepper JE, O'Connell MJ, Petroni GR, et al.: Adjuvant postoperative fluorouracil-modulated chemotherapy combined with pelvic radiation therapy for rectal cancer: initial results of intergroup 0114. J Clin Oncol 1997, 15(5):2030-2039.
• [17]Lee JH, Ahn JH, Bahng H, et al.: Randomized trial of postoperative adjuvant therapy in stage II and III rectal cancer to define the optimal sequence of chemotherapy and radiotherapy: a preliminary report. J Clin Oncol 2002, 20(7):1751-1758.
• [18]Folkesson J, Birgisson H, Pahlman L, Cedermark B, Glimelius B, Gunnarsson U: Swedish Rectal Cancer Trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol 2005, 23(24):5644-5650.
• [19]Improved survival with preoperative radiotherapy in resectable rectal cancer. Swedish Rectal Cancer Trial N Engl J Med 1997, 336(14):980-987.
• [20]Birgisson H, Pahlman L, Gunnarsson U, Glimelius B: Adverse effects of preoperative radiation therapy for rectal cancer: long-term follow-up of the Swedish Rectal Cancer Trial. J Clin Oncol 2005, 23(34):8697-8705.
• [21]Birgisson H, Pahlman L, Gunnarsson U, Glimelius B: Late gastrointestinal disorders after rectal cancer surgery with and without preoperative radiation therapy. Br J Surg 2008, 95(2):206-213.
• [22]Kapiteijn E, Marijnen CA, Nagtegaal ID, et al.: Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001, 345(9):638-646.
• [23]Sebag-Montefiore D, Stephens RJ, Steele R, et al.: Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial. Lancet 2009, 373(9666):811-820.
• [24]Bosset JF, Collette L, Calais G, et al.: Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 2006, 355(11):1114-1123.
• [25]Gerard JP, Conroy T, Bonnetain F, et al.: Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers: results of FFCD 9203. J Clin Oncol 2006, 24(28):4620-4625.
• [26]Roh MS, Colangelo LH, O'Connell MJ, et al.: Preoperative multimodality therapy improves disease-free survival in patients with carcinoma of the rectum: NSABP R-03. J Clin Oncol 2009, 27(31):5124-5130.
• [27]Roh MS, Colangelo L, Wieand S, et al.: Response to preoperative multimodality therapy predicts survival in patients with carcinoma of the rectum. ASCO Meeting Abstracts 2004, 22(14):3505.
• [28]Kim TH, Chie EK, Kim DY, et al.: Comparison of the belly board device method and the distended bladder method for reducing irradiated small bowel volumes in preoperative radiotherapy of rectal cancer patients. Int J Radiat Oncol Biol Phys 2005, 62(3):769-775.
• [29]Siddiqui F, Shi C, Papanikolaou N, Fuss M: Image-guidance protocol comparison: supine and prone set-up accuracy for pelvic radiation therapy. Acta Oncol 2008, 47(7):1344-1350.
• [30]Drzymala M, Hawkins MA, Henrys AJ, Bedford J, Norman A, Tait DM: The effect of treatment position, prone or supine, on dose-volume histograms for pelvic radiotherapy in patients with rectal cancer. Br J Radiol 2009, 82(976):321-327.
• [31]Tulchinsky H, Shmueli E, Figer A, Klausner JM, Rabau M: An interval >7 weeks between neoadjuvant therapy and surgery improves pathologic complete response and disease-free survival in patients with locally advanced rectal cancer. Ann Surg Oncol 2008, 15(10):2661-2667.
• [32]Habr-Gama A, Perez RO, Proscurshim I, et al.: Interval between surgery and neoadjuvant chemoradiation therapy for distal rectal cancer: does delayed surgery have an impact on outcome? Int J Radiat Oncol Biol Phys 2008, 71(4):1181-1188.
• [33]Roh MS, Yothers GA, O'Connell MJ, et al.: The impact of capecitabine and oxaliplatin in the preoperative multimodality treatment in patients with carcinoma of the rectum: NSABP R-04. ASCO Meeting Abstracts 2011, 29(15):3503.
• [34]Hofheinz R, Wenz FK, Post S, et al.: Capecitabine (Cape) versus 5-fluorouracil (5-FU)-based (neo)adjuvant chemoradiotherapy (CRT) for locally advanced rectal cancer (LARC): Long-term results of a randomized, phase III trial. ASCO Meeting Abstracts 2011, 29(15):3504.
• [35]Gerard JP, Azria D, Gourgou-Bourgade S, et al.: Comparison of two neoadjuvant chemoradiotherapy regimens for locally advanced rectal cancer: results of the phase III trial ACCORD 12/0405-Prodige 2. J Clin Oncol 2010, 28(10):1638-1644.
• [36]Valentini V, Coco C, Minsky BD, et al.: Randomized, multicenter, phase IIb study of preoperative chemoradiotherapy in T3 mid-distal rectal cancer: raltitrexed + oxaliplatin + radiotherapy versus cisplatin + 5-fluorouracil + radiotherapy. Int J Radiat Oncol Biol Phys 2008, 70(2):403-412.
• [37]Kiran RP, Nisar PJ, Pelley RJ, Fazio VW, Lavery IC: Role of routine adjuvant chemotherapy after neoadjuvant chemoradiotherapy and resection in low-risk patients with rectal cancer. ASCO Meeting Abstracts 2011, 29(15):e14032.
• [38]Garofalo M, Moughan J, Hong T, et al.: RTOG 0822: A Phase II Study of Preoperative (PREOP) Chemoradiotherapy (CRT) Utilizing IMRT in Combination with Capecitabine (C) and Oxaliplatin (O) for Patients with Locally Advanced Rectal Cancer. Int J Radiat Oncol Biol Phys 2011, 81(2):S3-S4.
• [39]Samuelian JM, Callister MD, Ashman JB, Young-Fadok TM, Borad MJ, Gunderson LL: Reduced acute bowel toxicity in patients treated with intensity-modulated radiotherapy for rectal cancer. Int J Radiat Oncol Biol Phys 2012, 82(5):1981-1987.
• [40]Fuller CD, Nijkamp J, Duppen JC, et al.: Prospective randomized double-blind pilot study of site-specific consensus atlas implementation for rectal cancer target volume delineation in the cooperative group setting. Int J Radiat Oncol Biol Phys 2011, 79(2):481-489.
• [41]Fuller CD, Nijkamp J, Rasch CR, et al.: Impact of rectal cancer target volume consensus atlas implementation in the cooperative group setting: Preliminary results from a prospective randomized double-blind pilot study. 2010. [Paper presented at: 2010 Gastrointestinal Cancers Symposium]
• [42]Myerson RJ, Garofalo MC, El Naqa I, et al.: Elective clinical target volumes for conformal therapy in anorectal cancer: a radiation therapy oncology group consensus panel contouring atlas. Int J Radiat Oncol Biol Phys 2009, 74(3):824-830.
• [43]Taylor N, Crane C, Skibber J, et al.: Elective groin irradiation is not indicated for patients with adenocarcinoma of the rectum extending to the anal canal. Int J Radiat Oncol Biol Phys 2001, 51(3):741-747.
• [44]Gunderson LL, Sargent DJ, Tepper JE, et al.: Impact of T and N substage on survival and disease relapse in adjuvant rectal cancer: a pooled analysis. Int J Radiat Oncol Biol Phys 2002, 54(2):386-396.
• [45]Gunderson LL, Sargent DJ, Tepper JE, et al.: Impact of T and N stage and treatment on survival and relapse in adjuvant rectal cancer: a pooled analysis. J Clin Oncol 2004, 22(10):1785-1796.
• [46]Guillem JG, Diaz-Gonzalez JA, Minsky BD, et al.: cT3N0 rectal cancer: potential overtreatment with preoperative chemoradiotherapy is warranted. J Clin Oncol 2008, 26(3):368-373.
• [47]Garcia-Aguilar J, Shi Q, Thomas CR Jr, et al.: A phase II trial of neoadjuvant chemoradiation and local excision for T2N0 rectal cancer: preliminary results of the ACOSOG Z6041 trial. Ann Surg Oncol 2012, 19(2):384-391.
• [48]Habr-Gama A, Perez RO, Proscurshim I, et al.: Patterns of failure and survival for nonoperative treatment of stage c0 distal rectal cancer following neoadjuvant chemoradiation therapy. J Gastrointest Surg 2006, 10(10):1319-1328. discussion 1328-1319