Sanghera, P., Wong, D. W. Y., McConkey, Christopher C., Geh, J. I. and Hartley, A.. (2008) Chemoradiotherapy for rectal cancer : an updated analysis of factors affecting pathological response. Clinical Oncology, Vol.20 (No.2). pp. 176-183. ISSN 0936-6555

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Abstract

Aims: With the aim of improving locoregional control, the use of preoperative chemoradiotherapy (CRT) for rectal cancer has increased. A pathological complete response (pCR) is often used as a surrogate marker for the efficacy of different CRT schedules. By analysing factors affecting pCR, this analysis aims to guide the development of future trials.

Materials and methods: Searches of Medline, EMBASE and the electronic American Society of Clinical Oncology abstract databases were carried out to identify prospective phase II and phase III trials using preoperative CRT to treat rectal cancer. Trials were eligible for inclusion if they defined: the CRT drugs, the radiation dose and the pCR rate. Phase I patients were excluded from the analysis. A multivariate analysis examined the effect of the above variables on the pCR rate and in addition the use of neoadjuvant chemotherapy, the type of publication (peer reviewed vs abstract), the year of publication and whether the cancers were stated to be inoperable, fixed or threatening the circumferential resection margin were included. The method of analysis used was weighted linear modelling of the pCR rate.

Results: Sixty-four phase II and seven phase III trials were identified including a total of 4732 patients. Statistically significant factors associated with pCR were the use of two drugs, the method of fluoropyrimidine administration (with continuous intravenous 5-fluorouracil being the most effective) and a higher radiotherapy dose. Although the use of two drugs was associated with a higher rate of pCR, no single schedule seemed to be more effective. None of the other factors analysed significantly influenced pCR.

Conclusions: A higher rate of pCR is seen in studies using two drugs, infusional 5-fluorouracil and a radiotherapy dose of 45 Gy and above.

Item Type:	Journal Article
Subjects:	R Medicine > RB Pathology R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer) R Medicine > RM Therapeutics. Pharmacology
Divisions:	Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Rectum -- Cancer -- Pathophysiology, Rectum -- Cancer -- Treatment -- Analysis, Chemotherapy, Radiotherapy
Journal or Publication Title:	Clinical Oncology
Publisher:	Elsevier Science London
ISSN:	0936-6555
Official Date:	March 2008
Dates:	Date Event March 2008 Published
Volume:	Vol.20
Number:	No.2
Number of Pages:	8
Page Range:	pp. 176-183
Identification Number:	10.1016/j.clon.2007.11.013
Status:	Peer Reviewed
Publication Status:	Published
URI:	http://wrap.warwick.ac.uk/id/eprint/30384

Data sourced from Thomson Reuters' Web of Knowledge

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