The use of preoperative radiotherapy in the management of patients with clinically resectable rectal cancer: a practice guideline

BACKGROUND: This systematic review with meta-analysis was designed to evaluate the literature and to develop recommendations regarding the use of preoperative radiotherapy in the management of patients with resectable rectal cancer. METHODS: The MEDLINE, CANCERLIT and Cochrane Library databases, and abstracts published in the annual proceedings of the American Society of Clinical Oncology and the American Society for Therapeutic Radiology and Oncology were systematically searched for evidence. Relevant reports were reviewed by four members of the Gastrointestinal Cancer Disease Site Group and the references from these reports were searched for additional trials. External review by Ontario practitioners was obtained through a mailed survey. Final approval of the practice guideline report was obtained from the Practice Guidelines Coordinating Committee. RESULTS: Two meta-analyses of preoperative radiotherapy versus surgery alone, nineteen trials that compared preoperative radiotherapy plus surgery to surgery alone, and five trials that compared preoperative radiotherapy to alternative treatments were obtained. Randomized trials demonstrate that preoperative radiotherapy followed by surgery is significantly more effective than surgery alone in preventing local recurrence in patients with resectable rectal cancer and it may also improve survival. A single trial, using surgery with total mesorectal excision, has shown similar benefits in local recurrence. CONCLUSION: For adult patients with clinically resectable rectal cancer we conclude that: • Preoperative radiotherapy is an acceptable alternative to the previous practice of postoperative radiotherapy for patients with stage II and III resectable rectal cancer; • Both preoperative and postoperative radiotherapy decrease local recurrence but neither improves survival as much as postoperative radiotherapy combined with chemotherapy. Therefore, if preoperative radiotherapy is used, chemotherapy should be added postoperatively to at least patients with stage III disease

Effect of Uncaria and Tabebuia extracts on molecular epidemiological biomarkers in patients with colorectal cancer

The combined effect of surgical treatment and consumption of so-called “CoD™ tea” (containing Uncaria guianensis, U. tomentosa and Tabebuia avellanedae) on expression of c-myc, Ha-ras, Bcl-2, Ki-ras and p53 key onco/suppressor genes, the carbohydrate antigen (CA19-9) and carcino-embryonic antigen (CEA) tumour markers in blood samples of patients with colorectal cancer (CRC) were investigated. Expression of genes followed the effect of the surgical treatment combined with neoadjuvant chemotherapeutic treatment; this may predict the outcome of carcinoma. Moreover their expressions might show possible additional effect of supportive therapy, e.g. CoD™ consumption. The antioxidant capacity of blood was also examined. Blood samples were taken at the day of, and one week, 3, 6 and 12 months after the surgical treatment. During that period patients got 0.25 l standard portion of CoD™ tea three times a day. The surgical treatment and neoadjuvant therapy were able to suppress the expression of c-myc, Ha-ras, Bcl-2, Ki-ras, p53 genes up to the twelfth month. Moreover, CoD™ tea together with conventional treatment caused a strong decrease in the expression of c-myc and Ha-ras oncogenes in comparison to the non-consumer control