Cancer du rectum - SAHGEED
Transcript of Cancer du rectum - SAHGEED
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Pr. Nicolas Magné, MD, PhD [email protected]
SAHGEED
Cancer du rectum : Indications et modalités des traitements adjuvants
Cours Intensif de Cancérologie Digestive FFCD - SAHGEED 16 &17 Septembre 2016
Palais de la Culture MOUFDI Zakaria
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Thésaurus SNFGE www tncd.org
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3
Thésaurus Rectum 2013 www tncd. org
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JP Gérard Crit Rev Oncol Hematol 2012
Sph Sphincter Saving
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CXB unique RT = high precision - eye guided
Small Volume (5cm3) : SAFE HIGH DOSE
30 Gy 2 min
Transanal Endoscopic Brachytherapy
X 50 Kv
Contact XB
HIGH DOSE RATE
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Day 1
uT2N0
Day 70
pT0N0 14 years
1999
cCR
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Neoadjuvant Treatment and cCR
cCR : 30-50% cCR : 60-85%
EBRT EBRT + boost endocavitary
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• Une escalade de dose sans toxicité grâce à la RT Contact
90 Gy / 3 séancee • Double les chances d’une Réponse clinique
complète qui permet une exérèse locale
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RT de CONTACT Papillon
Philips CXB 50 Kv
1968
1971
cCR
30 Gy 2mn
30 Gy
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Papillon + 2015
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Organ Preservation in Early Rectal
Adenocarcinoma
OPERA
Sponsor : Centre Antoine Lacassagne, Nice France
Investigator coordinator : J.P. Gérard - Nice
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Rationale OPERA
Ø Standard treatment T2-3 : TME
Even with ant-Resect. : bowel function
Ø Habr Gama : CRT – CCR – W.W. (surveillance)
Ø Contact x ray brachytherapy : 50 kv
Papillon 50TM : renaissance CXB
Liverpool – Clatterbridge – France – DK –
Sweeden
CXB boost vs CRT-EBRT (Habr G) : 30%
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Primary objective
To demonstrate that neoadjuvant CRT with a
CXB boost (arm B) is superior to same CRT
with EBRT boost (arm A) :
Rectum (organ) preservation at 3 years without
non salvageable local disease and permanent
derivative stoma
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Secondary objectives
Efficacy :
Ø cCR – Tumour regression clinical – pathological
Ø Rate of sphincter preservation
Ø Survival – OS – DFS – SS
Safety :
Ø Early – late toxicity (NCI – CTCAEV 4.0)
Ø Bowel function (modified LARS score)
Ø QOL (QLQ – C30, QLQ – CR29)
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Inclusion criteria
Ø Operable patient ≥ 18 years Ø Adenocarcinoma ≤ 10 cm anal Verge (lower, …) Ø cT2 cT3a cT3b (fat 1 to 5 mm) Ø < 5 cm diameter < ½ circumference (MRI) Ø N0 – N1 (L.N. < 8 mm) – M0 Ø No comorbidity preventing to perform treatment Ø Adequate birth control Ø Signed informed consent – health care insurance -
Fup
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M 69 y , T 3a N 0 (MRI)
April 2014
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4- 2014 M 69y MRI :T3a N0 CXB 90 Gy/3f + CAP 50
cCR 8-2014 - Loc Exc:ypT0 03-2015 NED
D1
D28
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Middle rectum Anal canal : 3 cm Lower Border T : 5+3 cm = 8cm Accessible to DRE
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T classification Nougaret et al. Radiology 2013
T3 a < 1 mm beyond Mus.Prop. T3b ≥ 1-5 mm T3c > 5-15 mm T3 d > 15 mm