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Chemoradiotherapy

Contents

1. Introduction
2. Aims of chemoradiotherapy
3. Staging
4. Adjuvant therapy
5. Palliative Chemotherapy

1. Introduction

• Only cure for colorectal cancer is complete surgical resection
• Only 70-80% are eligible for surgery at diagnosis
• Overall 5 year survival 50-60%
• Patients with metastatic disease - median survival of 6 months

2. Aims of Chemoradiotherapy

• TNM staging system for colorectal cancer is used for determining treatment strategies for individual patients diagnosed
• UICC - International Union against Cancer
• Neoadjuvant therapy (prior to surgery) - decrease tumour bulk to allow curative resection and decrease local recurrence rate
• Adjuvant therapy (in association with surgery) - performed to prevent local recurrence and distal metastases
• Palliative therapy - prolong survival, improve quality of life, control symptoms

3. Staging

• TNM staging system for colorectal cancer is used for determining treatment strategies for individual patients diagnosed
• UICC - International Union against Cancer
• T (Primary tumour)
  • TX - Primary tumour cannot be assessed
  • Tis - Carcinoma in situ
  • T1 - Tumour invades submucosa
  • T2 - Tumour invades muscularis propria
  • T3 - Tumour penetrates muscularis propria and invades subserosa
  • T4 - Tumour directly invades other organs or structures or perforates
• N (Nodal status)
  • NX  - Regional lymph nodes cannot be assessed
  • N0  - No metastases in regional lymph nodes
  • N1  - Metastases in one to three regional lymph nodes
  • N2  - Metastases in four or more regional lymph nodes
• M (Distant metastases)
  • MX Presence or absence cannot be determined
  • M0 No distant metastases detected
  • M1 Distant metastases detected

   

  UICC Stage		Survival Data
  I	T1-2, N0, M0	90%
  IIA	T3, N0, M0	60-85%
  IIB	T4, N0, M0
  IIIA	T1-2, N1, M0	25-65%
  IIIB	T3-4, N1, M0
  IIIC	T (any), N2, M0
  IV	T (any), N (any), M1	5-7%

   

4. Adjuvant therapy

4.1 Colon Cancer

• Fluorouracil based therapies are well established for patients with Stage III disease
• Capecitabine safe and efficient alternative to fluorouracil
• Decreases tumour recurrence and increases 5 year overall survival
• Not currently recommended for Stage II disease

4.1 Rectal Cancer

• Local recurrence following resection is a major problem in rectal cancer and prevention of local recurrence is an important goal
• Radiation therapy and Chemoradiotherapy are combined to increase sphincter preservation, prolong survival, decrease morbidity, improve tumour control by reducing the probability of local recurrence
• Neoadjuvant (Pre-op) Chemoradiotherapy is used for Stage II and III disease (inferior margin <10cm from anal verge)

5. Palliative Chemotherapy

• For inoperable disease
• Aims to improve overall survival and quality of life
• Oxaliplatin combined with fluorouracil used for treatment therapy