1 / 13

Bruce Minsky

What is the most appropriate therapy for a 50 year old patient with T3N+ rectal cancer and isolated resectable liver metastases?
Systemic chemotherapy->chemoradiation->surgery. Bruce Minsky. GCR-3 Randomized Phase II. · 108 pts. CAPOX RT. Surgery. CAPOX. CAPOX RT. Surgery.

nellis
Download Presentation

Bruce Minsky

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. What is the most appropriate therapy for a 50 year old patient with T3N+ rectal cancer and isolated resectable liver metastases?
Systemic chemotherapy->chemoradiation->surgery Bruce Minsky

  2. GCR-3 Randomized Phase II · 108 pts CAPOX RT Surgery CAPOX CAPOX RT Surgery CAPOX Fernandez-Martos et al. JCO 2010

  3. GCR-3 Randomized Phase II InductionStandardp % pCR 14 13 - % Gr 3-4 17 51 0.00004 toxicity % received 93 51 0.0001 all 4 cycles Fernandez-Martos et al. JCO 2010

  4. Delayed Surgery 1593 Pts, 2009-2011 Dutch surgical colorectal audit Preop CMT (45-50.4 Gy + Cap TME Sloothaak et al, Br J Surg 2013

  5. 5 Gy x 5 + Induction CT 50 pts resectable/abatable M1 (84% liver, 10% lung, 6% both) T2: 8%, T3: 76%, T4: 16% 5 G x 5 2 wks CAPOX/Bev x 6 6-8 wks Surg+ RFA Total 72% R0 resection (all sites) 64% 2-Yr recurrence 80% 2-Yr survival Pelvis 26% pCR 2/36 local recurrence at a median of 32 months Exp arm of RAPIDO phase III Van Dijk et al. Ann Oncol 2013

  6. 5 Gy x 5 + Induction CT · 44 evaluable pts · cT3-4, any N, any M · 5 Gy x 5 mFOLFOX6 x 4 · 30% ypT0, 32% ypN0 Myerson et al, ASCO GI 2012

  7. 5 Gy x 5 + Concurrent CT ∙ 73 pts, cT3-4 rectal cancer ∙ 5 Gy x 5 (IMRT) + modified Mayo (400/20) x 5 ∙ Surgery: 4-8 weeks ∙ pCR: 1.4% ∙ Gr 3+ Toxicity: 38% Yeo et al, IJROBP 2013

  8. Stockholm III Trial cT3, < 15 anal verge DoseSurgery 25 Gy 1 wk 25 Gy delayed 50 Gy delayed

  9. Stockholm III Trial % Postop Tox25 Gy-I25 Gy-D50 Gy-D Anast leak 12 7 7 Wound infect 21 15 14 Abd infec 7 4 4 Total 53 39 41 (p=0.01) Pettersson et al, Br J Surg 2013

  10. Phase II Randomized Trial: Post CMT Chemotherapy · 144 pts stage II/III rectal cancer ∙ CI5-FU + 50.4 Gy %Postop Rx%pCRComp CMT Surg (6 wks) 18 40 (6 wks) CMT mFOLFOX6 Surg 25 40 if cResponse (11 wks) (p=NS) Garcia-Aguilar et al, Ann Surg 2011

  11. Preop CMT + Bevacizumab %Grade 3+ Series#Preop%pCRToxicity Brown 26 FOLFOX 20 76 Bev/50.4 Austria 8 Cape/Bev 25 50 · Both trials stopped early due to toxicity Dipetrillo et al, IJROBP 2012 Resch et al. Radiother Oncol 2012

  12. Radiation Dose Escalation Phase III randomized 248 pts, cT3-4 50.4 pelvic RT + UFT/LV HDR: 5 Gy x 2 @ 1 cm cPRR0 (T3)TRG+2Surg Comp HDR + 22 99 44 19 * * None 20 90 29 19 * p = ss Jakobsen et al Proc ASCO 2011

  13. Conclusions • Induction CT does not compromise RT • Improved survival of pts with liver mets = increased chance of local recurrence • Short course RT or ChemoRT: both reasonable but need to weigh benefits vs. risks (rapid return to CT vs. toxicity)

More Related