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Giving chemotherapy and radiotherapy before surgery rather than after halved local recurrences of rectal cancer, caused less toxicity and let more patients keep their anal sphincter, without changing overall survival.
The German Rectal Cancer Study Group randomised 823 patients with locally advanced rectal cancer (clinical stage T3 or T4 or node-positive) to fluorouracil-based chemoradiotherapy either before or after total mesorectal excision, with both groups receiving further chemotherapy. Preoperative treatment reduced five-year local recurrence, lowered acute and long-term toxicity and increased sphincter-preserving surgery among patients whose tumours had been judged to need an abdominoperineal resection, while overall survival was the same in both arms.
This trial made preoperative chemoradiotherapy the standard for locally advanced rectal cancer worldwide and is the foundation on which total neoadjuvant therapy and watch-and-wait organ preservation were later built.
Shares Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016), Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer (Dutch TME trial), Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation, Rectal cancer.
Shares CAO/ARO/AIO-94 (German Rectal Cancer Study), Chemoradiation (chemoradiotherapy, CRT), Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation, Fluorouracil (5-FU).
Shares Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer (Dutch TME trial), Neoadjuvant / adjuvant / perioperative, Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation, Rectal cancer.
Shares Organ preservation (watch-and-wait, bladder-sparing, larynx preservation), Chemoradiation (chemoradiotherapy, CRT), Rectal cancer, Colorectal cancer.
Shares CAO/ARO/AIO-94 (German Rectal Cancer Study), Chemoradiation (chemoradiotherapy, CRT), Fluorouracil (5-FU), Rectal cancer.
Shares Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016), Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer (Dutch TME trial), Total neoadjuvant therapy (TNT, rectal cancer), Organ preservation (watch-and-wait, bladder-sparing, larynx preservation).
Shares Total neoadjuvant therapy (TNT, rectal cancer), Organ preservation (watch-and-wait, bladder-sparing, larynx preservation), Rectal cancer, Colorectal cancer.
Shares CAO/ARO/AIO-94 (German Rectal Cancer Study), Neoadjuvant / adjuvant / perioperative, Rectal cancer, Colorectal cancer.