演題抄録

ECCO/JSCO Joint Symposium

開催概要
開催回
第52回・2014年・横浜
 

Chemoradiotherapy for Rectal Cancer: Pros and Cons in Western and Eastern Countries

演題番号 : ECJS-4

[筆頭演者]
Watanabe Toshiaki:1 

1:The Dept. of Surgical Oncology, Faculty of Medicine, The University of Tokyo

 

In Western countries, the standard procedure in the treatment of rectal cancer is total mesorectal excision (TME) plus preoperative chemoradiotherapy (CRT). On the other hand, radiotherapy is not widely used in Japan and TME plus lateral node dissection is the standard procedure. Retrospective studies have shown that lateral node dissection reduces local recurrence rate and improves survival of rectal cancer patients. However, the usefulness of lateral node dissection has not been shown in a prospective trial. At the present time, a randomized controlled study is going on in Japan to evaluate the efficacy of lateral node dissection and it is expected that the final results of this trial will be shown after 2015. After this trial will show the possibility or limitation of lateral node dissection, it is essential to determine the role of CRT with or without lateral node dissection for the treatment of rectal cancer in Japan.
In Western countries, the standard procedure is CRT plus TME. However, in recent years, efforts have been made to avoid adverse events related to radiotherapy such as impairment of urinary or sexual function. One possibility is to eliminate candidates for CRT. Some studies show that low risk rectal cancer patients do not need preoperative radiotherapy and can go to surgery without any adjuvant treatments. Another possibility is the use of chemotherapy instead of CRT to avoid possible radiotherapy-related adverse events. At the present time trials are going on to evaluate whether radiotherapy can be omitted for patients who respond to neoadjuvant intensive chemotherapy. It is expected that this new strategy will provide with the possibility of avoiding the toxicities of radiation without compromising local control. Also, earlier introduction of full dose chemotherapy might improve distant control.
Both in Western and Eastern countries, intensive efforts are been made in search for a new strategy in the treatment of rectal cancer.

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