News Release

New approach offers hope to patients with rectal cancer

The European Society for Medical Oncology (ESMO)

Peer-Reviewed Publication

European Society for Medical Oncology

NOT FOR RELEASE BEFORE 12.00 BST, FRIDAY, 20 JUNE 2003

The outlook for patients with advanced rectal cancer is looking more promising with a new treatment approach developed by Professor Andres Cervantes' team in Spain. The results of a trial of chemo-radiation followed by surgery were presented at the European Society of Medical Oncology's conference in Edinburgh today (20 June), demonstrating how to prevent a recurrence of the cancer.

Rectal cancer is a very difficult condition to treat because of the high risk of relapse. New growths are likely to occur in the same area so the key to successful treatment lies in controlling the cancer locally.

At the University Hospital Clinic in Valencia, Professor Cervantes and his multi-disciplinary team of oncologists, radiologists, surgeons and pathologists treated 50 patients with chemo-radiation, followed by surgery and further chemotherapy.

Thirty-six men and 14 women, whose average age was 61 years old, were carefully selected for the trial. Magnetic resonance imaging and ultrasonography were used to predict their risk of relapse and if it seemed high, they received chemo-radiation therapy for five weeks before having an operation to remove the tumour. Six weeks after surgery, they had further chemotherapy for 16 weeks.

"The results were excellent," said Professor Cervantes. After two years, none of the patients had suffered a local relapse." However, he cautioned, the cancer spread elsewhere in the body in 12 people although this would be expected with rectal cancer. One of the main advantages of the new treatment strategy was that these patients did not necessarily require a colostomy.

"Our results suggest that chemo-radiation given before surgery can control the disease," said Dr Cervantes. Until recently, radiotherapy was considered to be the standard form of treatment after an operation, but his research has shown that given with chemotherapy before surgery, in selected patients, helps to control the development of cancer in the same area.

"Now that we know that it is possible to control cancer locally, we need to carry on with our research to find ways to control the spread of cancer to other parts of the body," he said.

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Opening times: Thursday, 19 June from 13.00-17.00
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At other times, please contact:
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Notes to Editors
About the European Society for Medical Oncology (ESMO)
ESMO believes that every cancer patient is entitled to the best possible treatment available. Since medicine is involved in every aspect of cancer therapy, cancer patients need to be treated by qualified medical oncologists. ESMO is the leading European Society that provides education and guidelines for medical oncologists to ensure optimal care for cancer patients. Its official scientific journal is Annals of Oncology. Since 1975, the Society has grown to include representatives from every European country and the six major geographical regions of the world. More information about the Society can be obtained at www.esmo.org.

The ESMO Summer Educational Conference (ESEC) takes place in Edinburgh, Scotland, UK – 19 – 22 June 2003.

Abstract No. 25PD - Discussion Time: 10.00-10.45, Sunday, 22 June 2003, Moorfoot Suite

Preoperative Chemoradiation Followed by Surgery and Adjuvant Chemotherapy for Locally Advanced Rectal Cancer: Results of a Quality Control Program in a Multidisciplinary Approach

Edith Rodriguez Braun (1), Isabel Chirivella (1), Eduardo Garcia-Granero (2), Ana Hernandez (3), Jose Lopez-Torrecilla (3), Blanca Hernando (1), Amelia Insa (1), Salvador Lledo (2), Javier Garcia-Conde (1), Andres Cervantes (1)
(1) Hematology and Medical Oncology, Hospital Clinico Universitario, Valencia, Spain
(2) Surgery, Hospital Clinico Universitario, Valencia, Spain
(3) Radiation Oncology, Hospital General Universitario, Valencia, Spain

To improve results of treatment of locally advanced rectal cancer, a quality control program was planned at the University Hospital in Valencia. A multidisciplinary team (medical and radiation oncology, radiology, pathology and colorectal surgery) was established to implement such a program. Preoperative chemoradiation was started using infusional 5-FU (300mg/m2/day) during days 1-5 of every week. Radiation was given to the tumor and adjacent lymphatic areas with daily fractions of 180 cGy till a dose of 45 Gy. Five weeks after radiation, surgery with total mesorectal excision was performed. Six weeks after surgery, adjuvant chemotherapy with protracted infusional 5FU was continued for 16 weeks. From May 98 to January 03, 50 patients were all staged with rectal ultrasonography. Resonance Magnetic Imaging was also used to define local stage. Patient characteristics: median age: 61 (35-81). Male/female: 36/14. Median distance from anal edge: 5 cm (0-12). Increased CEA levels in 18 (36%). Stage: uT4N1: 19 (38%); uT3uN1: 21(42%), uT4N0: 5(10%); uT3N0: 5(10%). All patients, excepting one, had surgery. In 57% a low anterior resection with a sphincter preservation technique was used. 90% of patients had R0 surgical procedures. Two patients had liver metastases and 3 had radial margins involved with tumor. Infrastaging was observed in 77,5% of patients. Patological complete responses were seen in 5 (10%) and 22 (45%) and 14 (28,5%) became stage I and II, respectively. No severe toxicity was observed. Mesorectum was complete in 38 (77,5%), incomplete in 3 and could not be assessed in 8. The median number of analyzed lymph nodes in the pathological specimen was 6 (0-27). After a median follow-up of 28 months, no local relapses have been observed. Twelve patients (24,4%) had systemic relapses. Median time to progression is 45 months. Estimated survival at five year is 75%. In conclusion, a multidisciplinary approach for patients with locally advanced rectal cancer is feasible and produces excellent local control. However, systemic relapses are the most common cause of failure. Future trials should study better chemotherapy to improve results.

Professor Andrés Cervantes

Professor Andrés Cervantes trained as a medical oncologist for four years at the University Hospital in Valencia, Spain. After that, he worked as a research fellow in the Oncology Lab at the Free University Hospital in Amsterdam, and obtained his PhD. For two years he specialized in multidrug resistance at the cellular pharmacology level.

Since 1991 he works in the Medical Oncology and Hematology Department at the University Hospital in Valencia, in the position of Associate Professor of Medicine. He leads a multidisciplinary team involved in research and treatment of gastrointestinal and ovarian cancer. He has participated in many clinical trials of new compounds in colorectal cancer. The training of young medical oncologists is important to him and therefore he is involved in educational activities designed especially for them. He belongs to the national Spanish and international scientific societies (ASCO, ESMO) and cooperative groups (TTD, EORTC, GEICO, IGCCG, etc…). He is also a member of the Educational Committee of the European Society of Medical Oncology (ESMO).


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