Table 1.
Clinical results in primary locally advanced rectal cancer: 3 decades review (2.659 patients).
| Author (year)/study period | Median follow-up | # patients | Stage | Treatment |
Surgery | 5 year LC | 5 yearDFS/OS | ||
|---|---|---|---|---|---|---|---|---|---|
| RT | CT | IORT | |||||||
| Nakfoor et al7 (1998) 1978–1996 | 41 months | 73 | T3T4 | Pre45-50.4 Gy | 5FU | 10–12.5 Gy 12.5–20 Gyelectrons |
R0 45 (62%) R + 28 (38%) |
89%65% | 63% OS32% OS |
| Weinstein et al8 1995 1987-1992 | 36 months | 11 | T3T4NxM0 | Pre 45 Gy | 5FU | R0 10 Gy R1 15 Gy R2 20 Gy electrons |
R0 9R + 2 | 100% | OS 67%(3 year) |
| Azinovic et al9 (2011) | n.s. | 59 | T3T4 | Pre 46 GyPost 13 Gy | 5FU | 10–15 Gy electrons | R0 | 1, 4, 93% | 77% OS, 52% OS |
| Sole et al10, (2014), 1995–2010 | 72.6 months | 335 | cT3-4 93%, cN + 69% | Pre, 45–50.4 Gy | Tegafur, Induction (62%), Folfox 4, Adjuvant 73% | 10–15 Gy electrons | R0 323, R1 12 | Infield 3,3%, 92% LRC (5–10 year) | 75% OS, 62% OS, (10 year) |
| Krempien et al11, (2006), 1991–2003, | 61 months | 210 | II-III-IV | Pre 88, Post 122, Median 41.4 Gy | Pre 88, Post 122, 5 FU 93% | 8–18 Gy, (median 10 Gy) electrons | R0 192, R1/2 18 | 93%, 91% (10 year), 98% inside IOERT field (5 year) | 69% OS, 51%, (10 year), 66% DFS |
| Kusters et al12, (2010), Up to 2005 | 56 months | 605 | T3 71%, T4 29% | Pre 45–50 Gy | 5 FU 64%, Postop CT 42% | 10–12.5 Gy electrons | R0 89%, R1 11% | 88% | 67% OS |
| Harrison et al13, (1998), 11/92–12/96 | 17.5 months | 22 | Primary unresectable | Pre 50 Gy | 5FU-LV | 10–20 Gy, brachytherapy | R0, R+ | 81% (2 year), R0 92% (2 year), R1 38% (2 year) | 69% DFS, (2 year), R0 77% DFS (2 year), R1 38% DFS (2 year) |
| Nuyttens et al14, (2004), 1997–2000 | 36 months | 18 | LARC | Pre/post | none, | 10 Gy, brachytherapy | Margins ≤ 2 mm | 19% (3 year) | R0 37% OS, R + 26% OS |
| Gunderson et al15, (1997), 1982–1993 | minimum follow-up of 18 months | 22 | LARC | Pre 50 Gy | 5 FU | 8–20 Gy (median 12.5 Gy), electrons | R0 83% | 75%, 92% (crude LC rate in R0) | 64% OS |
| Dubois et al16, (2011), 1993–2001 | 60.1 months | 72 | cT3 89%, cN + 33%, cN0 64% | Pre 40 Gy | Adjuvant 25% | 15 Gy, electrons | n.s. | 92% | 70% OS |
| , Roeder et al17, (2007), 1991–2004, , | 59 months | 243 | T3T4 | 41.4 Gy, 88 pre, 122 post | 88 pre | Median 10 Gy, R0 10 Gy, R1 12 Gy, R2 15 Gy, electrons | R0 224, R1/2 19 | 92%, Infield R 97% LC | n.s., |
| Kusters et al18, (2009), 1994–2006 | n.s. | 290 | LARC | pre 45–50.4 Gy, 86 pre | 204 pre, 39 post | , R0 10 Gy, R1 12.5 Gy, R2 15–17.5 Gy, electrons | R0, R+ | 87%, 47% of LR outside IORT field. | Median follow-up time for, surviving patients 45 months |
| Zhang et al19, (2015), n.s. | 78 months | 71 | pT4N0/pT1-4N+ | 45–50 Gy, N + post | 5FU + CDDP + oxali, 4–6 < years | 10–20 Gy, electrons, | R0 67 (94.4%), R1 4 (5.6%) | 90% | 75% OS, 69% DFS |
| Mathis et al20, (2008), 09/1981–02/2007, | n.s. | 106 | Unresectable, LARC, (Colon) | 45–55 Gy | 5 FU | 7.5 – 25 Gy, Median 12.5 Gy electrons, | R0, R2 | 86%, (40 colon) | 49% OS, |
| Sadahiro et al21, (2004), 1991–2001, | 67 months | 99 | T3-4NXM0 | 20 Gy | UFT | 15–25 Gy, electrons | 98% | 98% | 79% |
| Alberda et al22, (2014), 1996–2012 | n.s. | 31 | LARC | 45–50 Gy, (some patients 25 Gy in 5 fractions) | n.s. | 10 Gy brachytherapy | R0 ≤ 2 mm, R1 | 84% | n.s. |
| Valentini et al23, (2009), 1991–2006 | 31 months | 100 | T4M0 | 45–55 Gy | 5 FU | 10–15 Gy, electrons | R0 78%, | 100%, R0 90% | 59% OS, R0 68% OS, R1-R2 22% OS |
| Brady et al24, (2017), 1999–2015 | n.s. | 37 | LARC | 50 Gy | 5 FU | 9–12 Gy, electrons | R + 24%, | 84%, 5.4% infield | mean OS, 47 months |
| Zhang et al25, (2014), 1996–2007 | 72.9 months | 45 | pT3N0M0 | none | Adjuvant, 5FU, CDDP, Oxali, LV | 15–25 Gy, electrons | TME (95%) | 84% | 84% OS, 71% DFS |
| Holman et al26, (2016), 1981–2010, | 52 months | 417 | T4 | 45–54 Gy, 78% pre | 5 FU, Adjuvant 19% | R0, R1 10–12.5 Gy, R2 > 15 Gy electrons | R0 73% | 81% LC, | 56% OS, (all patients), 64% OS (R0), 55% DFS |
| Calvo et al27, (2015), 1/00–12/13 | 62 months | 54 | cT4NxM0 | 50 Gy | Tegafur, Neo FOLFOX-4x2 (77%), Adjuvant (73%) | 10–20 Gy, electrons | R0 83% | 77% | 75% OS, 67% DFS |
LARC: locally advanced rectal cancer, LC: local control, OS: overall survival, DFS: disease-free survival, R0: negative resection margins; R1: microscopic positive resection margins; R2: gross residual tumor, n.s.: not stated.