Benefits Of Using Induction Ct Essay

1732 WordsOct 19, 20167 Pages
Introduction Treating locally advanced rectal cancer includes radiotherapy (RT), chemotherapy (CT), chemoradiotherapy (CRT), surgery, and subsequent incorporation of molecularly targeted agents. With multimodality treatment, local recurrence rates became less than 10% with the predominant mode of failure is the development of distant metastases (30–35%). Therefore, the addition of induction CT is not aimed to improve local efficacy, but to better control distant disease [1, 2]. The neoadjuvant RT/CRT has been shown to be superior to adjuvant treatment for a variety of endpoints [3, 4]. Approximately 50% of patients did not receive the planned adjuvant CT dose commonly due to toxicity and patient refusal [5, 6, 7]. Theoretical advantages of induction CT include; better treatment compliance, ability to deliver full systemic doses of CT with possibility of tumor shrinking that facilitate more effective local treatment. The tumor shrinkage potentially improves tumor vascularity with eventually improving oxygenation and increase intratumoral concentration of cytotoxic drugs [8, 9]. Additionally, induction CT has the potential to eradicate early distant micrometastases. On the other hand, it may be associated with selection of radioresistant clones, induction of accelerated repopulation, possibly reduced compliance to CRT, and a delay of definitive surgery [10]. Preliminary data from the Royal Marsden Hospital have shown that, in patients with poor-risk rectal cancer,
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