Preoperative chemoradiation versus radiation alone for stage II and III resectable rectal cancer

Background : Preoperative radiotherapy (RT) decreases local recurrence rate and improves survival in stage II and III rectal cancer patients. The combination of chemotherapy with RT has a sound radiobiological rationale, and phase II trials of combined chemoradiation (CRT) have shown promising activity in rectal cancer. Objectives : To compare preoperative RT with preoperative CRT in patients with resectable stage II and III rectal cancer. Search methods : We searched the Cochrane Register of Controlled Trials, Web of Science, Embase.com, and Pubmed from 1975 until June 2012. A manual search was performed of Ann Surg, Arch Surg, Cancer, J Clin Oncol, Int J Radiat Oncol Biol Phys and the proceedings of ASTRO, ECCO and ASCO from 1990 until June 2012. Selection criteria : Relevant studies randomized resectable stage II or III rectal cancer patients to at least one arm of preoperative RT alone or at least one arm of preoperative CRT. Data collection and analysis : Primary outcome parameters included overall survival (OS) at 5 years and local recurrence (LR) rate at 5 years. Secondary outcome parameters included disease free survival (DFS) at 5 years, metastasis rate, pathological complete response rate, clinical response rate, sphincter preservation rate, acute toxicity, postoperative mortality and morbidity, and anastomotic leak rate. Outcome parameters were summarized using the Odds Ratio (OR) and associated 95% confidence interval (CI) using the fixed effects model. Main results : Five trials were identified and included in the meta-analysis. From one of the included trials only preliminary data are reported. The addition of chemotherapy to preoperative RT significantly increased grade III and IV acute toxicity (OR 1.68-10, P = 0.002) and marginally affected postoperative overall morbidity (OR 0.67-1.00, P = 0.05) while no differences were observed in postoperative mortality or anastomotic leak rate. Compared to preoperative RT alone, preoperative CRT significantly increased the rate of complete pathological response (OR 2.12-5.84, P < 0.00001) although this did not translate into a higher sphincter preservation rate (OR 0.92-1.30, P = 0.32). The incidence of local recurrence at five years was significantly lower in the CRT group compared to RT alone (OR 0.39-0.72, P < 0.001). No statistically significant differences were observed in DFS (OR 0.92-1.34, P = 0.27) or OS (OR 0.79-1.14, P = 0.58) at five years. Authors' conclusions : Compared to preoperative RT alone, preoperative CRT enhances pathological response and improves local control in resectable stage II and III rectal cancer, but does not benefit disease free or overall survival. The effects of preoperative CRT on functional outcome and quality of life are incompletely understood and should be addressed in future trials

Board Engagement in IT Governance: Opening Up the Black Box of IT Oversight Committees at Board Level

Researchers and practitioners seem to agree on the importance of boards of directors engaging in IT governance. Yet, only a minority of boards around the globe are taking up accountability for governing IT, pointing towards a knowing-doing gap. Efforts have been made to close this gap by creating implementation guidelines for this type of engagement. One of the most frequently mentioned guidelines is the implementation of an IT oversight or similar committee at board level. However, research shows that few boards have established such a committee, which might be caused by the lack of detailed guidance on the workings and role of such committees. This paper discusses the case of the University of Antwerp that has established two IT oversight committees at board level. We demonstrate how IT oversight committees can be established and how they fit into the role of the board with regard to IT governance

National corporate governance codes and IT governance transparency in annual reports

IT governance is concerned with the oversight of IT assets, their contribution to business value and the mitigation of IT-related risks. Emerging research calls for more board level engagement in IT governance and identifies profound consequences for digitized organizations in case the board is not involved. Against this context, this article analyses how corporate governance codes are guiding boards to provide transparency on how they treat IT governance. The findings show that only the South African corporate governance code, King III, contains a significant amount of IT (governance)-related content. As a second objective, this article builds on these findings by providing an exploratory insight in the contemporary state of IT governance transparency in Belgian and South African companies. This way, the influence of the national corporate governance code on IT governance transparency is explored. The authors' findings show that South African firms tend to be more concerned with IT governance transparency in their annual reports than Belgian firms, given a comparable IT strategic role and ownership structure. Accordingly, the case is made for including more IT (governance)-related guidance in national corporate governance codes, as this might enable companies to be more transparent about their IT governance

How Boards of Directors Can Contribute to Governing IT

Digital transformation is becoming ubiquitous as organizations increasingly rely on IT to create business value. As a result, IT strategy is increasingly intertwined with organizational strategy, with risks as IT becomes progressively more important, requiring both management and governance. Given boards of directors are ultimately accountable for strategic decision-making and control, these changes charge boards with accountability for governing digital assets. Whilst board-level IT governance should enable better organizational performance, research suggests that the value created by the board in governing IT depends on the roles they play. In exploring these roles, we use the more mature research domain of corporate governance to develop improved understanding of the type of board roles and the importance assigned by a board to governing IT