State of the Art Radiotherapy in the Treatment of Colorectal Cancer: What Exactly Do They Do? Dr. Andrew Pearce
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State of the Art Radiotherapy in the Treatment of Colorectal Cancer: What Exactly Do They Do? Dr. Andrew Pearce

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Dr. Andrew Pearce's Presentation from the 2013 Regional Oncology Conference.

Dr. Andrew Pearce's Presentation from the 2013 Regional Oncology Conference.

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State of the Art Radiotherapy in the Treatment of Colorectal Cancer: What Exactly Do They Do? Dr. Andrew Pearce State of the Art Radiotherapy in the Treatment of Colorectal Cancer: What Exactly Do They Do? Dr. Andrew Pearce Presentation Transcript

  • State of the Art Radiotherapy in the Treatment of Colorectal Cancer: What Exactly Do They Do? Andrew Pearce MSc MD FRCPC Chief, Dept of Oncology, Health Sciences North Assistant Professor, Northern Ontario School of Medicine Radiation 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
  • • 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 FRCPC Chief, Dept of Oncology, Health Sciences North Assistant Professor, Northern Ontario School of Medicine Radiation Oncologist, Northeast Cancer Centre, HSN / ADCP