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11 Cards in this Set

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Rectum - when is local excision an option?

T1 (very few T2), upto 8-10cm, <40% of circumference, mod-well differentiated, no LVI

Rectum - adjuvant RT,?

LVI, close margins, poorly differentiated

TME reduces local recurrence to how much?

<10%

Dutch TME?

Neoadjuvant RT +TME vs TME alone.


Preop RT reduced local failure but mostly in T3-4 and/or Node positive and low lying tumors

Preop RT vs Postop RT

Preop shown to improve local control, DFS, OS vs surgery lone.


Postop vs surgery alone shows only benefit in local control

German trial

Preop chemorad vs postop chemorad (1.8gy, continuos 5FU). Local failure improved 13-->6% with preop. less acute and late toxiciites with preop. no DFS benefit./.


Also less APR done.



NASBP R03

Similar to german, preop chemort to 50.4g only T3-T4 or node positive. DFS improved 53%-->65% with preop. OS only trend.



Short-course RT vs long course RT in rectum

5x5 or 50.4 in 28 fractions. no difference in local control or survival. more early toxicity with long course, more late toxicity (10%) with short course.

Chemotherapy for concurrent RT. evidence for which drug?

only 5FU or xeloda

adjuvant chemotherapy ?

FOLFOX (from colon, no data in rectum) if T3-4 or N+ (consider CRT if not given preop)

Meta analysis for preoperative RT vs surgery

Better 5yos for preop