1
|
Toroń M, Wołoszyn A. [Organ-sparing treatment of node-positive bladder cancer]. Strahlenther Onkol 2023; 199:1255-1257. [PMID: 37773268 PMCID: PMC10673725 DOI: 10.1007/s00066-023-02156-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Małgorzata Toroń
- Klinik für Strahlentherapie, Christian-Albrechts-Universität zu Kiel, Kiel, Deutschland.
- Schlesische Medizinische Universität in Katowice, Katowice, Polen.
| | - Antoni Wołoszyn
- Klinik für Strahlentherapie, Christian-Albrechts-Universität zu Kiel, Kiel, Deutschland
- Schlesische Medizinische Universität in Katowice, Katowice, Polen
| |
Collapse
|
2
|
Rouprêt M, Pignot G, Masson-Lecomte A, Compérat E, Audenet F, Roumiguié M, Houédé N, Larré S, Brunelle S, Xylinas E, Neuzillet Y, Méjean A. [French ccAFU guidelines - update 2020-2022: bladder cancer]. Prog Urol 2021; 30:S78-S135. [PMID: 33349431 DOI: 10.1016/s1166-7087(20)30751-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE - To update French guidelines for the management of bladder cancer specifically non-muscle invasive (NMIBC) and muscle-invasive bladder cancers (MIBC). METHODS - A Medline search was achieved between 2018 and 2020, notably regarding diagnosis, options of treatment and follow-up of bladder cancer, to evaluate different references with levels of evidence. RESULTS - Diagnosis of NMIBC (Ta, T1, CIS) is based on a complete deep resection of the tumor. The use of fluorescence and a second-look indication are essential to improve initial diagnosis. Risks of both recurrence and progression can be estimated using the EORTC score. A stratification of patients into low, intermediate and high risk groups is pivotal for recommending adjuvant treatment: instillation of chemotherapy (immediate post-operative, standard schedule) or intravesical BCG (standard schedule and maintenance). Cystectomy is recommended in BCG-refractory patients. Extension evaluation of MIBC is based on contrast-enhanced pelvic-abdominal and thoracic CT-scan. Multiparametric MRI can be an alternative. Cystectomy associated with extended lymph nodes dissection is considered the gold standard for non-metastatic MIBC. It should be preceded by cisplatin-based neoadjuvant chemotherapy in eligible patients. An orthotopic bladder substitution should be proposed to both male and female patients with no contraindication and in cases of negative frozen urethral samples; otherwise transileal ureterostomy is recommended as urinary diversion. All patients should be included in an Early Recovery After Surgery (ERAS) protocol. For metastatic MIBC, first-line chemotherapy using platin is recommended (GC or MVAC), when performans status (PS <1) and renal function (creatinine clearance >60 mL/min) allow it (only in 50% of cases). In second line treatment, immunotherapy with pembrolizumab demonstrated a significant improvement in overall survival. CONCLUSION - These updated French guidelines will contribute to increase the level of urological care for the diagnosis and treatment of patients diagnosed with NMIBC and MIBC.
Collapse
Affiliation(s)
- M Rouprêt
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Sorbonne Université, GRC n° 5, Predictive onco-uro, AP-HP, hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - G Pignot
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, Institut Paoli-Calmettes, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - A Masson-Lecomte
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Saint-Louis, Université Paris-Diderot, 10, avenue de Verdun, 75010 Paris, France
| | - E Compérat
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'anatomie pathologique, hôpital Tenon, HUEP, Sorbonne Université, GRC n° 5, ONCOTYPE-URO, 4, rue de la Chine, 75020 Paris, France
| | - F Audenet
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Foch, Université de Versailles - Saint-Quentin-en-Yvelines, 40, rue Worth, 92150 Suresnes, France
| | - M Roumiguié
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Département d'urologie, CHU Rangueil, 1, avenue du Professeur-Jean-Poulhès, 31400 Toulouse, France
| | - N Houédé
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Département d'oncologie médicale, CHU Carémeau, Université de Montpellier, rue du Professeur-Robert-Debré, 30900 Nîmes, France
| | - S Larré
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Reims, rue du Général Koenig, 51100 Reims, France
| | - S Brunelle
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de radiologie, Institut Paoli-Calmettes, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - E Xylinas
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Bichat-Claude-Bernard, Assistance publique-Hôpitaux de Paris, Université Paris-Descartes, 46, rue Henri-Huchard, 75018 Paris, France
| | - Y Neuzillet
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Reims, rue du Général Koenig, 51100 Reims, France
| | - A Méjean
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, Université de Paris, 20, rue Leblanc, 75015 Paris, France
| |
Collapse
|
3
|
Rouprêt M, Neuzillet Y, Pignot G, Compérat E, Audenet F, Houédé N, Larré S, Masson-Lecomte A, Colin P, Brunelle S, Xylinas E, Roumiguié M, Méjean A. French ccAFU guidelines – Update 2018–2020: Bladder cancer. Prog Urol 2020; 28:R48-R80. [PMID: 32093463 DOI: 10.1016/j.purol.2019.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 07/30/2018] [Indexed: 12/27/2022]
Abstract
Objective To propose updated French guidelines for non-muscle invasive (NMIBC) and muscle-invasive (MIBC) bladder cancers. Methods A Medline search was achieved between 2015 and 2018, as regards diagnosis, options of treatment and follow-up of bladder cancer, to evaluate different references with levels of evidence. Results Diagnosis of NMIBC (Ta, T1, CIS) is based on a complete deep resection of the tumor. The use of fluorescence and a second-look indication are essential to improve initial diagnosis. Risks of both recurrence and progression can be estimated using the EORTC score. A stratification of patients into low, intermediate and high risk groups is pivotal for recommending adjuvant treatment: instillation of chemotherapy (immediate post-operative, standard schedule) or intravesical BCG (standard schedule and maintenance). Cystectomy is recommended in BCG-refractory patients. Extension evaluation of MIBC is based on contrast-enhanced pelvic-abdominal and thoracic CT-scan. Multiparametric MRI can be an alternative. Cystectomy associated with extended lymph nodes dissection is considered the gold standard for non-metastatic MIBC. It should be preceded by cisplatin-based neoadjuvant chemotherapy in eligible patients. An orthotopic bladder substitution should be proposed to both male and female patients with no contraindication and in cases of negative frozen urethral samples; otherwise transileal ureterostomy is recommended as urinary diversion. All patients should be included in an Early Recovery After Surgery (ERAS) protocol. For metastatic MIBC, first-line chemotherapy using platin is recommended (GC or MVAC), when performans status (PS < 1) and renal function (creatinine clearance > 60 mL/min) allow it (only in 50 % of cases). In second line treatment, immunotherapy with pembrolizumab demonstrated a significant improvement in overall survival. Conclusion These updated French guidelines will contribute to increase the level of urological care for the diagnosis and treatment for NMIBC and MIBC.
Collapse
Affiliation(s)
- M Rouprêt
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,GRC no 5, ONCOTYPE-URO, hôpital Pitié-Salpêtrière, Sorbonne université, AP–HP, 75013 Paris, France
| | - Y Neuzillet
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Service d’urologie, hôpital Foch, université de Versailles-Saint-Quentin-en-Yvelines, 92150 Suresnes, France
| | - G Pignot
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Service de chirurgie oncologique 2, institut Paoli-Calmettes, 13008 Marseille, France
| | - E Compérat
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Service d’anatomie pathologique, GRC no 5, ONCOTYPE-URO, hôpital Tenon, HUEP, Sorbonne université, AP-HP, 75020 Paris, France
| | - F Audenet
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Service d’urologie, hôpital européen Georges-Pompidou, université Paris Descartes, AP–HP, 75015 Paris, France
| | - N Houédé
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Département d’oncologie médicale, CHU Caremaux, Montpellier université, 30000 Nîmes, France
| | - S Larré
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Service d’urologie, CHU de Reims, Reims, 51100 France
| | - A Masson-Lecomte
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Service d’urologie, hôpital Saint-Louis, université Paris-Diderot, AP–HP, 75010 Paris, France
| | - P Colin
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Service d’urologie, hôpital privé de la Louvière, 59800 Lille, France
| | - S Brunelle
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Service de radiologie, institut Paoli-Calmettes, 13008 Marseille, France
| | - E Xylinas
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Service d’urologie de l’hôpital Bichat-Claude-Bernard, université Paris-Descartes, AP–HP, 75018 Paris, France
| | - M Roumiguié
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Département d’urologie, CHU Rangueil, Toulouse, 31000 France
| | - A Méjean
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Service d’urologie, hôpital européen Georges-Pompidou, université Paris Descartes, AP–HP, 75015 Paris, France
| |
Collapse
|
4
|
Merten R, Ott O, Haderlein M, Bertz S, Hartmann A, Wullich B, Keck B, Kühn R, Rödel CM, Weiss C, Gall C, Uter W, Fietkau R. Long-Term Experience of Chemoradiotherapy Combined with Deep Regional Hyperthermia for Organ Preservation in High-Risk Bladder Cancer (Ta, Tis, T1, T2). Oncologist 2019; 24:e1341-e1350. [PMID: 31292267 PMCID: PMC6975936 DOI: 10.1634/theoncologist.2018-0280] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 02/11/2019] [Indexed: 01/19/2023] Open
Abstract
This article reports on the different treatments for bladder cancer and related effects on frequency of bladder preservation, disease‐free survival, and overall survival, with a focus on the efficacy and safety of chemoradiotherapy combined with regional deep hyperthermia of high‐risk bladder cancer after transurethral resection of bladder tumor. Background. The aim of this study was to evaluate the efficacy and safety of chemoradiotherapy (RCT) combined with regional deep hyperthermia (RHT) of high‐risk bladder cancer after transurethral resection of bladder tumor (TUR‐BT). Materials and methods. Between 1982 and 2016, 369 patients with pTa, pTis, pT1, and pT2 cN0–1 cM0 bladder cancer were treated with a multimodal treatment after TUR‐BT. All patients received radiotherapy (RT) of the bladder and regional lymph nodes. RCT was administered to 215 patients, RCT + RHT was administered to 79 patients, and RT was used in 75 patients. Treatment response was evaluated 4–6 weeks after treatment with TUR‐BT. Results. Complete response (CR) overall was 83% (290/351), and in treatment groups was RT 68% (45/66), RCT 86% (178/208), and RCT + RHT 87% (67/77). CR was significantly improved by concurrent RCT compared with RT (odds ratio [OR], 2.32; 95% confidence interval [CI], 1.05–5.12; p = .037), less influenced by hyperthermia (OR, 2.56; 95% CI, 0.88–8.00; p = .092). Overall survival (OS) after RCT was superior to RT (hazard ratio [HR], 0.7; 95% CI, 0.50–0.99; p = .045). Five‐year OS from unadjusted Kaplan‐Meier estimates was RCT 64% versus RT 45%. Additional RHT increased 5‐year OS to 87% (HR, 0.32; 95% CI, 0.18–0.58; p = .0001). RCT + RHT compared with RCT showed a significantly better bladder‐preservation rate (HR, 0.13; 95% CI, 0.03–0.56; p = .006). Median follow‐up was 71 months. The median number of RHT sessions was five. Conclusion. The multimodal treatment consisted of a maximal TUR‐BT followed by RT; concomitant platinum‐based chemotherapy combined with RHT in patients with high‐grade bladder cancer improves local control, bladder‐preservation rate, and OS. It offers a promising alternative to surgical therapies like radical cystectomy. Implications for Practice. Radical cystectomy with appropriate lymph node dissection has long represented the standard of care for muscle‐invasive bladder cancer in medically fit patients, despite many centers reporting excellent long‐term results for bladder preserving strategies. This retrospective analysis compares different therapeutic modalities in bladder‐preservation therapy. The results of this study show that multimodal treatment consisting of maximal transurethral resection of bladder tumor followed by radiotherapy, concomitant platinum‐based chemotherapy combined with regional deep hyperthermia in patients with Ta, Tis, T1–2 bladder carcinomas improves local control, bladder‐preservation rate, and survival. More importantly, these findings offer a promising alternative to surgical therapies like radical cystectomy. The authors hope that, in the future, closer collaboration between urologists and radiotherapists will further improve treatments and therapies for the benefit of patients.
Collapse
Affiliation(s)
- Ricarda Merten
- Department of Radiation Oncology, Universitätsklinikum Erlangen Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Oliver Ott
- Department of Radiation Oncology, Universitätsklinikum Erlangen Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Marlen Haderlein
- Department of Radiation Oncology, Universitätsklinikum Erlangen Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Simone Bertz
- Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Bernd Wullich
- Department of Urology and Pediatric Urology, Universitätsklinikum Erlangen Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Bastian Keck
- Department of Urology and Pediatric Urology, Universitätsklinikum Erlangen Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Reinhard Kühn
- Department of Urology, Martha Maria Medical Center, Nuremberg, Germany
| | - Claus Michael Rödel
- Department of Radiotherapy and Oncology, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Christian Weiss
- Department of Radiation Oncology, Klinikum Darmstadt GmbH, Darmstadt, Germany
| | - Christine Gall
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, Universitätsklinikum Erlangen Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| |
Collapse
|
5
|
Rouprêt M, Neuzillet Y, Pignot G, Compérat E, Audenet F, Houédé N, Larré S, Masson-Lecomte A, Colin P, Brunelle S, Xylinas E, Roumiguié M, Méjean A. RETRACTED: Recommandations françaises du Comité de Cancérologie de l’AFU — Actualisation 2018—2020 : tumeurs de la vessie French ccAFU guidelines — Update 2018—2020: Bladder cancer. Prog Urol 2018; 28:S46-S78. [PMID: 30366708 DOI: 10.1016/j.purol.2018.07.283] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 07/30/2018] [Indexed: 12/24/2022]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). Cet article est retiré de la publication à la demande des auteurs car ils ont apporté des modifications significatives sur des points scientifiques après la publication de la première version des recommandations. Le nouvel article est disponible à cette adresse: doi:10.1016/j.purol.2019.01.006. C’est cette nouvelle version qui doit être utilisée pour citer l’article. This article has been retracted at the request of the authors, as it is not based on the definitive version of the text because some scientific data has been corrected since the first issue was published. The replacement has been published at the doi:10.1016/j.purol.2019.01.006. That newer version of the text should be used when citing the article.
Collapse
Affiliation(s)
- M Rouprêt
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Sorbonne université, GRC no5, ONCOTYPE-URO, hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France.
| | - Y Neuzillet
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Foch, université de Versailles-Saint-Quentin-en-Yvelines, 92150 Suresnes, France
| | - G Pignot
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de chirurgie oncologique 2, institut Paoli-Calmettes, 13008 Marseille, France
| | - E Compérat
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'anatomie pathologique, hôpital Tenon, HUEP, Sorbonne université, GRC no5, ONCOTYPE-URO, 75020 Paris, France
| | - F Audenet
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital européen Georges-Pompidou, université Paris Descartes, AP-HP, 75015 Paris, France
| | - N Houédé
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Département d'oncologie médicale, CHU Caremaux, Montpellier université, 30000 Nîmes, France
| | - S Larré
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Reims, Reims, 51100 France
| | - A Masson-Lecomte
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Saint-Louis, université Paris-Diderot, 75010 Paris, France
| | - P Colin
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital privé de la Louvière, 59800 Lille, France
| | - S Brunelle
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de radiologie, institut Paoli-Calmettes, 13008 Marseille, France
| | - E Xylinas
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie de l'hôpital Bichat-Claude-Bernard, université Paris-Descartes, Assistance publique-Hôpitaux de Paris, 75018 Paris, France
| | - M Roumiguié
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Département d'urologie, CHU Rangueil, Toulouse, 31000 France
| | - A Méjean
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital européen Georges-Pompidou, université Paris Descartes, AP-HP, 75015 Paris, France
| |
Collapse
|
6
|
Groselj B, Ruan JL, Scott H, Gorrill J, Nicholson J, Kelly J, Anbalagan S, Thompson J, Stratford MRL, Jevons SJ, Hammond EM, Scudamore CL, Kerr M, Kiltie AE. Radiosensitization In Vivo by Histone Deacetylase Inhibition with No Increase in Early Normal Tissue Radiation Toxicity. Mol Cancer Ther 2018; 17:381-392. [PMID: 28839000 PMCID: PMC5712223 DOI: 10.1158/1535-7163.mct-17-0011] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 06/01/2017] [Accepted: 07/21/2017] [Indexed: 02/06/2023]
Abstract
As the population ages, more elderly patients require radiotherapy-based treatment for their pelvic malignancies, including muscle-invasive bladder cancer, as they are unfit for major surgery. Therefore, there is an urgent need to find radiosensitizing agents minimally toxic to normal tissues, including bowel and bladder, for such patients. We developed methods to determine normal tissue toxicity severity in intestine and bladder in vivo, using novel radiotherapy techniques on a small animal radiation research platform (SARRP). The effects of panobinostat on in vivo tumor growth delay were evaluated using subcutaneous xenografts in athymic nude mice. Panobinostat concentration levels in xenografts, plasma, and normal tissues were measured in CD1-nude mice. CD1-nude mice were treated with drug/irradiation combinations to assess acute normal tissue effects in small intestine using the intestinal crypt assay, and later effects in small and large intestine at 11 weeks by stool assessment and at 12 weeks by histologic examination. In vitro effects of panobinostat were assessed by qPCR and of panobinostat, TMP195, and mocetinostat by clonogenic assay, and Western blot analysis. Panobinostat resulted in growth delay in RT112 bladder cancer xenografts but did not significantly increase acute (3.75 days) or 12 weeks' normal tissue radiation toxicity. Radiosensitization by panobinostat was effective in hypoxic bladder cancer cells and associated with class I HDAC inhibition, and protein downregulation of HDAC2 and MRE11. Pan-HDAC inhibition is a promising strategy for radiosensitization, but more selective agents may be more useful radiosensitizers clinically, resulting in fewer systemic side effects. Mol Cancer Ther; 17(2); 381-92. ©2017 AACRSee all articles in this MCT Focus section, "Developmental Therapeutics in Radiation Oncology."
Collapse
Affiliation(s)
- Blaz Groselj
- CRUK/MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Jia-Ling Ruan
- CRUK/MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Helen Scott
- CRUK/MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Jessica Gorrill
- CRUK/MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Judith Nicholson
- CRUK/MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Jacqueline Kelly
- CRUK/MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Selvakumar Anbalagan
- CRUK/MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - James Thompson
- CRUK/MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Michael R L Stratford
- CRUK/MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Sarah J Jevons
- CRUK/MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Ester M Hammond
- CRUK/MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Cheryl L Scudamore
- Mary Lyons Centre MRC Harwell, Harwell Science and Innovation Campus, Oxfordshire, United Kingdom
| | - Martin Kerr
- CRUK/MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Anne E Kiltie
- CRUK/MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom.
| |
Collapse
|
7
|
Díaz Beveridge R, Akhoundova D, Bruixola G, Aparicio J. Controversies in the multimodality management of locally advanced rectal cancer. Med Oncol 2017; 34:102. [DOI: 10.1007/s12032-017-0964-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 04/18/2017] [Indexed: 12/11/2022]
|
8
|
Rouprêt M, Neuzillet Y, Masson-Lecomte A, Colin P, Compérat E, Dubosq F, Houédé N, Larré S, Pignot G, Puech P, Roumiguié M, Xylinas E, Méjean A. Recommandations en onco-urologie 2016-2018 du CCAFU : Tumeurs de la vessie. Prog Urol 2016; 27 Suppl 1:S67-S91. [DOI: 10.1016/s1166-7087(16)30704-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
9
|
Gerardi MA, Jereczek-Fossa BA, Zerini D, Surgo A, Dicuonzo S, Spoto R, Fodor C, Verri E, Rocca MC, Nolè F, Muto M, Ferro M, Musi G, Bottero D, Matei DV, De Cobelli O, Orecchia R. Bladder preservation in non-metastatic muscle-invasive bladder cancer (MIBC): a single-institution experience. Ecancermedicalscience 2016; 10:657. [PMID: 27563352 PMCID: PMC4970626 DOI: 10.3332/ecancer.2016.657] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Indexed: 12/23/2022] Open
Abstract
The aim of this study is to access the feasibility, toxicity profile, and tumour outcome of an organ preservation curative approach in non-metastatic muscle-invasive bladder cancer. A retrospective analysis was conducted on patients affected by M0 bladder cancer, who refused cystectomy and were treated with a curative approach. The standard bladder preservation scheme included maximal transurethral resection of bladder tumour (TURBT) and combination of radiotherapy and platin-based chemotherapy, followed by endoscopic evaluation, urine cytology, and instrumental evaluation. Thirteen patients fulfilled the inclusion criteria. TNM stage was cT2cN0M0 and cT2cNxM0, in 12 and one patients, respectively. All patients had transitional cell cancer. Twelve patients completed the whole therapeutic programme (a bimodal treatment without chemotherapy for one patient). Median follow-up is 36 months. None of the patients developed severe urinary or intestinal acute toxicity. In 10 patients with a follow-up > 6 months, no cases of severe late toxicity were observed. Response evaluated in 12 patients included complete response and stable disease in 11 patients (92%), and one patient (8%), respectively. At the time of data analysis (March 2016), 10 patients (77%) are alive with no evidence of disease, two patients (15%) died for other reasons, and one patient has suspicious persistent local disease. The trimodality approach, including maximal TURBT, radiotherapy, and chemotherapy for muscle-invasive bladder cancer, is well-tolerated and might be considered a valid and feasible option in fit patients who refuse radical cystectomy.
Collapse
Affiliation(s)
- Marianna A Gerardi
- Department of Oncology and Haemato-oncology, University of Milan, 20122 Milan, Italy; Division of Radiotherapy, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Barbara A Jereczek-Fossa
- Department of Oncology and Haemato-oncology, University of Milan, 20122 Milan, Italy; Division of Radiotherapy, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Dario Zerini
- Division of Radiotherapy, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Alessia Surgo
- Department of Oncology and Haemato-oncology, University of Milan, 20122 Milan, Italy; Division of Radiotherapy, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Samantha Dicuonzo
- Department of Oncology and Haemato-oncology, University of Milan, 20122 Milan, Italy; Division of Radiotherapy, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Ruggero Spoto
- Department of Oncology and Haemato-oncology, University of Milan, 20122 Milan, Italy; Division of Radiotherapy, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Cristiana Fodor
- Division of Radiotherapy, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Elena Verri
- Medical Division of Urogenital Tumours, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Maria Cossu Rocca
- Medical Division of Urogenital Tumours, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Franco Nolè
- Medical Division of Urogenital Tumours, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Matteo Muto
- Department of Oncology and Haemato-oncology, University of Milan, 20122 Milan, Italy; Division of Radiotherapy, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Matteo Ferro
- Division of Urologic Cancer Surgery, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Gennaro Musi
- Division of Urologic Cancer Surgery, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Danilo Bottero
- Division of Urologic Cancer Surgery, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Deliu V Matei
- Division of Urologic Cancer Surgery, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Ottavio De Cobelli
- Department of Oncology and Haemato-oncology, University of Milan, 20122 Milan, Italy; Division of Urologic Cancer Surgery, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Roberto Orecchia
- Department of Oncology and Haemato-oncology, University of Milan, 20122 Milan, Italy; Division of Radiotherapy, European Institute of Oncology IRCCS, 20141 Milan, Italy
| |
Collapse
|
10
|
Feuerstein MA, Goenka A. Quality of Life Outcomes for Bladder Cancer Patients Undergoing Bladder Preservation with Radiotherapy. Curr Urol Rep 2016; 16:75. [PMID: 26343030 DOI: 10.1007/s11934-015-0547-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
For patients with muscle-invasive bladder cancer, the decision to undergo radical cystectomy or bladder preservation treatment must incorporate survival differences, toxicity, and quality of life. Our objective was to review patient-reported outcomes for bladder preservation treatment with a focus on patients eligible for radical cystectomy, for whom a comparison of patient-reported outcomes is most relevant. Peer-reviewed, English-language manuscripts in MEDLINE and PubMed databases were examined from 1996 through 2014. Subject headings included quality of life, bladder cancer, bladder sparing, bladder preservation, radiation, and radiotherapy. Prospective and retrospective studies of patient-reported outcomes in patients undergoing bladder preservation with radiotherapy for muscle-invasive bladder cancer were included. Two prospective studies and four retrospective studies were identified. Several weaknesses from these studies were identified including small sample sizes, variable time points of assessment, variation in treatment regimens, and failure to use validated or condition-specific questionnaires. From the available data, bladder preservation appears to result to similar or better general quality of life compared to radical cystectomy with satisfactory urinary and sexual function reported in most series. In general, bladder preservation resulted in more gastrointestinal symptoms than radical cystectomy. This is one of the first reviews on the subject of patient-reported outcomes for bladder preservation in muscle-invasive bladder cancer. Although the data are limited, this review may provide a framework for developing well-designed, prospective comparisons of treatment for this patient cohort.
Collapse
Affiliation(s)
- Michael A Feuerstein
- Department of Urology, Lenox Hill Hospital, Hofstra-North Shore LIJ School of Medicine, 170 East 77th Street, New York, NY, 10075, USA,
| | | |
Collapse
|
11
|
Milowsky MI, Rumble RB, Booth CM, Gilligan T, Eapen LJ, Hauke RJ, Boumansour P, Lee CT. Guideline on Muscle-Invasive and Metastatic Bladder Cancer (European Association of Urology Guideline): American Society of Clinical Oncology Clinical Practice Guideline Endorsement. J Clin Oncol 2016; 34:1945-52. [PMID: 27001593 DOI: 10.1200/jco.2015.65.9797] [Citation(s) in RCA: 172] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To endorse the European Association of Urology guideline on muscle-invasive (MIBC) and metastatic bladder cancer. The American Society of Clinical Oncology (ASCO) has a policy and set of procedures for endorsing clinical practice guidelines that have been developed by other professional organizations. METHODS The guideline on MIBC and metastatic bladder cancer was reviewed for developmental rigor by methodologists. The ASCO Endorsement Panel then reviewed the content and recommendations. RESULTS The ASCO Endorsement Panel determined that the recommendations from the European Association of Urology guideline on MIBC and metastatic bladder cancer, published online in March 2015, are clear, thorough, and based on the most relevant scientific evidence. ASCO endorses the guideline on MIBC and metastatic bladder cancer and has added qualifying statements, including highlighting the use of chemoradiotherapy for select patients with MIBC and recommending a preference for clinical trials in the treatment of metastatic disease in the second-line setting. RECOMMENDATIONS Multidisciplinary care for patients with MIBC and metastatic bladder cancer is critical. The standard treatment of MIBC (cT2-T4a N0M0) is neoadjuvant cisplatin-based combination chemotherapy followed by radical cystectomy. In cisplatin-ineligible patients, radical cystectomy alone is recommended. Adjuvant cisplatin-based chemotherapy may be offered to high-risk patients who have not received neoadjuvant therapy. Chemoradiotherapy may be offered as an alternative to cystectomy in appropriately selected patients with MIBC and in some patients for whom cystectomy is not an option. Metastatic disease should be treated with cisplatin-containing combination chemotherapy or with carboplatin combination chemotherapy or single agents in patients ineligible for cisplatin.Additional information is available at http://www.asco.org/endorsements/MIBC and www.asco.org/guidelineswiki.
Collapse
Affiliation(s)
- Matthew I Milowsky
- Matthew I. Milowsky, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Christopher M. Booth, Queen's University, Kingston; Libni J. Eapen, Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Timothy Gilligan, Cleveland Clinic, Cleveland, OH; Ralph J. Hauke, Nebraska Cancer Specialists, Omaha, NE; Pat Boumansour, Patient Representative, Palm Coast, FL; and Cheryl T. Lee, University of Michigan, Ann Arbor, MI
| | - R Bryan Rumble
- Matthew I. Milowsky, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Christopher M. Booth, Queen's University, Kingston; Libni J. Eapen, Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Timothy Gilligan, Cleveland Clinic, Cleveland, OH; Ralph J. Hauke, Nebraska Cancer Specialists, Omaha, NE; Pat Boumansour, Patient Representative, Palm Coast, FL; and Cheryl T. Lee, University of Michigan, Ann Arbor, MI
| | - Christopher M Booth
- Matthew I. Milowsky, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Christopher M. Booth, Queen's University, Kingston; Libni J. Eapen, Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Timothy Gilligan, Cleveland Clinic, Cleveland, OH; Ralph J. Hauke, Nebraska Cancer Specialists, Omaha, NE; Pat Boumansour, Patient Representative, Palm Coast, FL; and Cheryl T. Lee, University of Michigan, Ann Arbor, MI
| | - Timothy Gilligan
- Matthew I. Milowsky, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Christopher M. Booth, Queen's University, Kingston; Libni J. Eapen, Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Timothy Gilligan, Cleveland Clinic, Cleveland, OH; Ralph J. Hauke, Nebraska Cancer Specialists, Omaha, NE; Pat Boumansour, Patient Representative, Palm Coast, FL; and Cheryl T. Lee, University of Michigan, Ann Arbor, MI
| | - Libni J Eapen
- Matthew I. Milowsky, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Christopher M. Booth, Queen's University, Kingston; Libni J. Eapen, Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Timothy Gilligan, Cleveland Clinic, Cleveland, OH; Ralph J. Hauke, Nebraska Cancer Specialists, Omaha, NE; Pat Boumansour, Patient Representative, Palm Coast, FL; and Cheryl T. Lee, University of Michigan, Ann Arbor, MI
| | - Ralph J Hauke
- Matthew I. Milowsky, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Christopher M. Booth, Queen's University, Kingston; Libni J. Eapen, Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Timothy Gilligan, Cleveland Clinic, Cleveland, OH; Ralph J. Hauke, Nebraska Cancer Specialists, Omaha, NE; Pat Boumansour, Patient Representative, Palm Coast, FL; and Cheryl T. Lee, University of Michigan, Ann Arbor, MI
| | - Pat Boumansour
- Matthew I. Milowsky, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Christopher M. Booth, Queen's University, Kingston; Libni J. Eapen, Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Timothy Gilligan, Cleveland Clinic, Cleveland, OH; Ralph J. Hauke, Nebraska Cancer Specialists, Omaha, NE; Pat Boumansour, Patient Representative, Palm Coast, FL; and Cheryl T. Lee, University of Michigan, Ann Arbor, MI
| | - Cheryl T Lee
- Matthew I. Milowsky, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Christopher M. Booth, Queen's University, Kingston; Libni J. Eapen, Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Timothy Gilligan, Cleveland Clinic, Cleveland, OH; Ralph J. Hauke, Nebraska Cancer Specialists, Omaha, NE; Pat Boumansour, Patient Representative, Palm Coast, FL; and Cheryl T. Lee, University of Michigan, Ann Arbor, MI
| |
Collapse
|
12
|
Thavaneswaran S, Price TJ. Optimal therapy for resectable rectal cancer. Expert Rev Anticancer Ther 2015; 16:285-302. [PMID: 26652907 DOI: 10.1586/14737140.2016.1130627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A lot can be gained by improving our understanding of the optimal sequence of existing therapies in rectal cancer, with the more difficult task of balancing the morbidity of recurrence with the morbidity of prescribed therapies that are particularly toxic owing to tumour location. This review aims to highlight a recent shift in treatment strategies in the opposite direction, with a focus on earlier, more intense systemic treatments with reduced local therapies. Understanding the rationale for and evidence to support this shift will help identify gaps, shape future trials, and ultimately answer the question of whether this is indeed the right path to follow with regards to maintaining local control rates and long-term outcomes for patients, and improving distal disease control and local treatment-related morbidities without compromising quality of life.
Collapse
Affiliation(s)
| | - Timothy J Price
- b The Queen Elizabeth Hospital , University of Sydney and University of Adelaide , Woodville , SA , Australia
| |
Collapse
|
13
|
Beyond conventional chemotherapy: Emerging molecular targeted and immunotherapy strategies in urothelial carcinoma. Cancer Treat Rev 2015; 41:699-706. [PMID: 26138514 DOI: 10.1016/j.ctrv.2015.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 06/17/2015] [Indexed: 01/20/2023]
Abstract
Advanced urothelial carcinoma is frequently lethal, and improvements in cytotoxic chemotherapy have plateaued. Recent technological advances allows for a comprehensive analysis of genomic alterations in a timely manner. The Cancer Genome Atlas (TCGA) study revealed that there are numerous genomic aberrations in muscle-invasive urothelial carcinoma, such as TP53, ARID1A, PIK3CA, ERCC2, FGFR3, and HER2. Molecular targeted therapies against similar genetic alterations are currently available for other malignancies, but their efficacy in urothelial carcinoma has not been established. This review describes the genomic landscape of malignant urothelial carcinomas, with an emphasis on the potential to prosecute these tumours by deploying novel targeted agents and immunotherapy in appropriately selected patient populations.
Collapse
|
14
|
Poulsen LØ, Qvortrup C, Pfeiffer P, Yilmaz M, Falkmer U, Sorbye H. Review on adjuvant chemotherapy for rectal cancer - why do treatment guidelines differ so much? Acta Oncol 2015; 54:437-46. [PMID: 25597332 DOI: 10.3109/0284186x.2014.993768] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The use of postoperative adjuvant chemotherapy is controversial for rectal adenocarcinoma. Both international and national guidelines display a great span varying from recommending no adjuvant chemotherapy at all, over single drug 5-fluororuacil (5-FU), to combinations of 5-FU/oxaliplatin. METHODS A review of the literature was made identifying 24 randomized controlled trials on adjuvant treatment of rectal cancer based on about 10 000 patients. The trials were subdivided into a number of clinically relevant subgroups. RESULTS As regards patients treated with preoperative (chemo) radiotherapy, four randomized studies were found where use of adjuvant chemotherapy showed no benefit in survival. Three trials were found in which a subset of patients received preoperative (chemo) radiotherapy. Two of these trials showed a statistically significant benefit of adjuvant chemotherapy. Twenty trials were identified in which the patients did not receive preoperative (chemo) radiotherapy, including five Asian studies in which a statistically significant benefit from adjuvant chemotherapy was reported. CONCLUSIONS Most of the data found did not support the use of postoperative adjuvant chemotherapy for patients already treated with preoperative (chemo) radiotherapy. For patients not treated preoperatively, several studies support the use of single agent 5-FU chemotherapy. Treatment guidelines seem to differ according to if preoperative chemoradiation is considered of importance for use of adjuvant chemotherapy and if adjuvant colon cancer studies are considered transferrable to rectal cancer patients regardless of the molecular differences.
Collapse
Affiliation(s)
- Laurids Ø Poulsen
- Department of Oncology, Aalborg University Hospital , Aalborg , Denmark
| | | | | | | | | | | |
Collapse
|