Short-course radiotherapy in stage IV rectal cancer with resectable disease.

INTRODUCTION: Stage IV rectal cancer with resectable disease presents challenging issues, as the radical treatment of the whole disease is difficult. Surgery and chemotherapy (CT) play an unquestionable role, but the contribution of pelvic radiotherapy (RT) is not very clear. METHODS: In 2009, we established a prospective treatment protocol that included CT, short-course preoperative radiotherapy (SCRT) with surgery of the primary tumour and all metastatic locations. RESULTS: Forty patients were included. Eight (20%) patients did not receive CT due to significant comorbidities. Radical surgery treatment was possible in 22 (55%) patients. The mean follow-up was 42.81 months (3.63-105.97). Overall survival at 24 and 36 months was 71.4% and 58.2%, respectively. There was good local control of the disease, as 97.2% of pelvic surgeries were R0 and there were no local recurrences. CONCLUSION: In stage IV with resectable metastatic disease, the proposed therapeutic regimen seems very appropriate in well selected patients able to tolerate the treatment. We bet on the role of pelvic RT, due to the good local control of the disease in our series.

External beam irradiation for T1, T2-3 and T4 transitional cell carcinoma of the urinary bladder.

Fifty-seven patients with T1 transitional cell carcinoma of the bladder, 57 patients with T2-3 and 10 patients with T4 were treated by radical irradiation +/- salvage cystectomy. Thirty-five patients with T1 were treated by transurethral resection (TUR) plus local chemotherapy +/- salvage cystectomy. Eleven patients with T2-3 were treated with 5 X 4 Gy in one week followed by cystectomy while four patients with T2-3 were treated with 40 Gy in 4 weeks also followed by cystectomy. Five patients with T4 were treated with 40 Gy in 4 weeks plus cystectomy. Seven year survival rates are: 69% for T1 treated by radical irradiation, 43% for T1 treated by TUR (p less than 0.02), 36% for T2-3 treated either by radical irradiation or 5 X 4 Gy plus cystectomy, and 18% for T4 treated by radical irradiation. All the survival rates indicated are free of disease and include the cases in which salvage cystectomy was successfully performed. Sixty per cent of the cured patients conserved very good functional bladders. We believe that external beam irradiation plus salvage cystectomy is indicated in the treatment of T1 and T2-3 tumours of the bladder.

Response to neoadjuvant therapy for rectal cancer: influence on long-term results.

OBJECTIVE: Pre-operative treatment with chemoradiotherapy (CRT) seems to improve local control and overall survival in patients with rectal cancer. The aims of the study were to analyse the impact on overall, disease free and cancer related survival of tumour response to pre-operative CRT and to analyse the influence of the degree of response on long-terms results. PATIENTS AND METHODS: Patients with a locally advanced rectal cancer, treated by pre-operative CRT were studied. A radical resection of the rectal tumour with mesorectal excision was performed within 6-8 weeks. Judged on the final TNM classification patients were considered responders when the tumour showed histologically a complete response, microscopic residual disease or a partial response. Non-responders were those in whom the extent of disease remained stable or progressed. Results Radical excision was performed in 103 patients, and a palliative resection in five. Forty-three patients underwent abdominoperineal resection and 65 anterior resection of the rectum. Seventy-one (65.7%) patients showed a response to CRT, while 37 (34.3%) did not. The overall local and distant recurrence rates were 6.8% and 21.3%. Tumour recurrence (P < 0.008) and disease free survival (P < 0.007) were significantly different in responders and nonresponders. Of the 71 responders, 16 had a pathological complete response, 27 had persisting microscopic disease and 28 had macroscopic residual disease. No differences in cancer specific outcome were observed in these groups. CONCLUSION: Pathological response to pre-operative CRT is associated with improved tumour recurrence and disease-free survival rates. Any response to pre-operative CRT appears to improve outcomes as much as a complete response.