The purpose of this study is to establish the influence of time-interval between preoperative hyperfractionated radiotherapy (5x5 Gy) and surgery on long term overall survival (5 years), local and distant recurrence rate, downstaging rate, sphincter saving procedures, radical resection rate (R0) in patients with locally advanced rectal cancer operated on according to TME technique. In particular 3D endosonography and 3rd generation ultrasonic contrast agents are evaluated to assess response to radiotherapy.
The treatment group comprises patients with locally advanced rectal cancer who were operated on in the 1st Department of General Surgery, Jagiellonian University, Cracow. The data on survival has been systematically collected using national census registry. Patients are qualified to preoperative radiotherapy 5x5 Gy and then randomly assigned to subgroups with different time interval between radiotherapy and surgery: one subgroup consists of patients operated on 7-10 days after the end of irradiation, the second subgroup consists of patients operated on after 4-5 weeks. Both should be homogenous in sex, age, cancer stage and localization, distal and circumferential resection margins, number of resected lymph nodes. 3D endorectal ultrasound and endorectal ultrasound with SonoVue are performed to assess the tumor before and after preoperative radiotherapy.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
154
Preoperative radiotherapy 5x5 Gy (total dose of 25 Gy)
Total mesorectal excision of rectal cancer
First Department of Surgery
Krakow, Malopolska, Poland
local and systemic recurrence rate
Rate of local and sytemic recurrences in patients included to the protocol.
Time frame: 5 years
radical resections rate (R0)
Rate of R0, R1 and R2 procedures according to Hermanek.
Time frame: 1 month
sphincter saving (sparing) procedures
Rate of sphincter saving operations in both arms.
Time frame: 1 month
overall survival
Overall survival and disease specific survival at 5 years follow-up
Time frame: 5 years
downstaging of rectal cancer
Downstaging of the rectal cancer after preoprearite radiotherapy - assessed by comparison of preoperative ERUS, 3D ERUS, contrast enhanced ERUS and postoperative histologic staging
Time frame: 1 month
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