PROCEDURES - Chemoradiotherapy

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 Â - Regional lymph nodes cannot be assessed
N0 Â - No metastases in regional lymph nodes
N1 Â - Metastases in one to three regional lymph nodes
N2 Â - 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