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State of the Art Radiotherapy
in the Treatment of Colorectal
Cancer: What Exactly Do
They Do?
Andrew Pearce MSc MD FRCPC
C...
• 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 + R...
• 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 ca...
• 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 ...
• 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 ...
• 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 met...
• Chemo RT for six weeks pre op is standard of care
•Modern Radiotherapy combines:
• Multiple diagnostic imaging modalitie...
State of the Art Radiotherapy
in the Treatment of Colorectal
Cancer: What Exactly Do
They Do?
Andrew Pearce MSc MD FRCPC
C...
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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.

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

  1. 1. 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
  2. 2. • 1168 pts 1987 – 1990 • 25Gy / 5 treatments over 1 week • Surgery within one week • vs. Surgery alone
  3. 3. years
  4. 4. years
  5. 5. years
  6. 6. • Surgery alone 27% local recurrence • Surgery + RT 11% local recurrence • 5 yr OS Surgery alone 48% • 5 yr OS Surgery + RT 58%
  7. 7. • 1861 pts • 25Gy / 5 treatments over 1 week - Surgery (TME) • Vs. TME alone
  8. 8. • 2yr LR w TME alone 8.2% • 2yr LR w RT and TME 2.4% • At 5 yrs 10.9 vs. 5.6%
  9. 9. • T3 or T4 or node +v3 • inferior margin within 16cm of anal verge • Preop chemorads vs post op chemo rads • TME in all cases
  10. 10. • 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
  11. 11. • Cases where surgeon did not feel sphincter could be spared: • Pre op – did spare 39% • Post op – did spare 19%
  12. 12. 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
  13. 13. • 25Gy / 5 days versus 50.5 Gy in 5 wks w chemo • 326 pts • 3yr LR
  14. 14. • 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
  15. 15. • 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
  16. 16. 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
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