Subscribe to RSS
DOI: 10.1055/s-2006-946549
© J. A. Barth Verlag in Georg Thieme Verlag KG
Rektumkarzinom: Behandeln wir zu häufig neoadjuvant? Vorschläge zu einer selektiveren, MRT-basierten Indikation
Rectal Carcinoma: Is Too Much Neoadjuvant Therapy Performed? Proposals for a More Selective MRI Based IndicationPublication History
Publication Date:
24 August 2006 (online)
Zusammenfassung
Die moderne optimierte Chirurgie (Konzept der totalen Mesorektumexzision) mit Qualitätssicherung durch standardisierte pathologische Untersuchung, strahlentherapeutische Fortschritte und die Möglichkeiten der hochauflösenden Dünnschicht-MRT erfordern eine neue Abwägung der Indikation zur multimodalen Therapie des Rektumkarzinoms. Danach ist eine neoadjuvante Langzeit-Radiochemotherapie indiziert bei Patienten mit hohem lokoregionärem Rezidivrisiko. Dies sind Patienten mit 1) fixierten fraglich resektablen Tumoren, 2) beweglichen Tumoren, bei denen nach dem MRT-Befund der Tumor die Fascia mesorectalis befällt oder von ihr 1 mm oder weniger entfernt ist, 3) tiefsitzenden Tumoren, die unter den Levatoransatz reichen und jenseits der Muscularis propria infiltrieren. Eine adjuvante Radiochemotherapie ist dann angezeigt, wenn sich ein erhöhtes Lokalrezidivrisiko aufgrund des intraoperativen Verlaufs (Tumorperforation, Schnitt in bzw. durch Tumor) oder der pathologischen Untersuchung des Tumorresektats (inkomplette Mesorektumexzision, Tumor 1 mm oder weniger vom zirkumferentiellen Resektionsrand entfernt) ergibt. Bei Patienten mit Lymphknotenmetastasen, jedoch geringem Lokalrezidivrisiko ist eine postoperative Chemotherapie empfehlenswert.
Abstract
The present-day optimised surgery (concept of total mesorectal excision) with quality assurance by standardized pathologic examination, advances in radiotherapy and the possibilities of high-spatial-resolution MR imaging require reconsideration of pros and contras of neoadjuvant therapy and respective data. According to the resulting new proposal neoadjuvant long-course radiochemotherapy is indicated for patients with 1) fixed questionably R0 resectable tumors, 2) mobile tumors with the MRT finding of tumor involving the mesorectal fascia or 1 mm or less from it, 3) low rectal tumors extending below the levator origin and invading beyond the muscularis propria. If a high risk of local recurrence becomes apparent during surgery (tumor perforation, incision into or through tumor) or after pathologic examination (incomplete mesorectal excision, tumor 1 mm or less from the circumferential resection margin) adjuvant radiochemotherapy is indicated. In case of lymph node metastasis postoperative chemotherapy is given.
Schlüsselwörter
Magnetresonanztomographie - Mesorektumexzision - Multimodale Therapie - Neoadjuvante Langzeit-Radiochemotherapie - Rektumkarzinom
Key words
Magnetic resonance imaging - Mesorectal excision - Multimodal treatment - Neoadjuvant long-course radiochemotherapy - Rectal carcinoma
Literatur
- 1 Abulafi AM, Williams NS. Local recurrence of colorectal cancer: the problem, mechanism, management and adjuvant therapy. Br J Surg. 1994; 81 7-19
- 2 Adams DR, Blatchford GJ, Lin KM. et al. . Use of preoperative ultrasound staging for treatment of rectal cancer. Dis Colon Rect. 1999; 42 159-166
- 3 Adlard JW, Richman SD, Seymour MT, Quirke P. Predictors of the response of colorectal cancer to systemic therapy. Lancet Oncol. 2002; 3 75-82
- 4 Akasu T, Iinuma G, Fujita T. et al. . Thin-section MRI with a phased-array coil for preoperative evaluation of pelvic anatomy and tumor extent in patients with rectal cancer. Am J Radiol. 2005; 134 531-538
- 5 Allal AS, Bieri S, Pelloni A. et al. . Sphincter-sparing surgery after preoperative radiotherapy for low rectal cancers: feasibility, oncologic results and quality of life outcomes. Br J Cancer. 2000; 82 1131-1137
- 6 Arbman G, Nilsson E, Hallbrock O, Sjödahl R. Local recurrence following total mesorectal excision for rectal cancer. Br J Surg. 1996; 83 375-379
- 7 Bali C, Nousias V, Fatourros M. et al. . Assessment of local stages in rectal cancer using endorectal ultrasonography (EUS). Techn Coloproctol. 2004; 8 170-173
- 8 Bartram C, Brown G. Endorectal ultrasound and magnetic resonance imgaging in rectal cancer staging. Gastroenterol Clin N Amer. 2002; 31 827-839
- 9 Bedrosian I, Rodriguez-Bigas MA, Feig B. et al. . Predicting the node-negative mesorectum after preoperative chemoradiation for locally advanced rectal carcinoma. J Gastrointest Surg. 2004; 8 56-63
- 10 Beets-Tan RGH, Beets GL, Vliegen RFA. et al. . Accuracy of magnetic resonance imaging in prediction of tumor-free resection margins in rectal cancer surgery. Lancet. 2001; 357 497-504
- 11 Beets-Tan RGH, Beets GL. Rectal cancer: review with emphasis on MR imaging. Radiology. 2004; 232 335-346
- 12 Belli L, Beati CA, Frangi M. et al. . Outcome of patients with rectal cancer treated by stapled anterior resection. Br J Surg. 1988; 75 422-424
- 13 Bellin M-F, Lebleu L, Meric J-B. Evaluation of retroperitoneal and pelvic lymph node metastases with MRI and MR lymphangiography. Abdom Imaging. 2003; 28 155-163
- 14 Beresford M, Glynne-Jones R, Richman P. et al. . The reliability of lymph-node staging in rectal cancer after preoperative chemoradiotherapy. Clin Oncol (R Coll Radiol). 2005; 17 448-455
- 15 Berufsverband Deutscher Pathologen und Deutsche Gesellschaft für Pathologie . Empfehlungen zur Pathologischen Diagnostik des kolorektalen Karzinoms. Berufsverband Deutscher Pathologen, Gelsenkirchen. 2005; www.bv-pathologie.de
- 16 Birbeck KF, Macklin CP, Tiffin NJ. et al. . Rates of circumferential resection margin involvement vary between surgeons and predict outcomes in rectal cancer surgery. Ann Surg. 2002; 35 449-457
- 17 Birgisson H, Pahlman L, Gunnarsson U, Glimelius B. Occurrence of second cancers in patients treated with radiotherapy for rectal cancer. J Clin Oncol. 2005; 23 6126-6131
- 18 Bissett IP, Fernando CC, Hough DM. et al. . Identification of the fascia propria by magnetic resonance imaging and its relevance to pre-operative assessment of rectal cancer. Dis Colon Rectum. 2001; 44 259-265
- 19 Bloch BN, Rofsky NM, Baroni RH. et al. . 3 Tesla magnetic resonance imaging of the prostate with combined pelvic phased-array and endorectal coils: initial experience. Acad Radiol. 2004; 11 863-867
- 20 Bjerkeset T, Edna TH. Rectal cancer: the influence of type of operation on local recurrence and survival. Eur J Surg. 1996; 162 643-648
- 21 Blomqvist L, Machado M, Rubio C. et al. . Rectal tumour staging : MR imgaging using pelvic phased-array and endorectal coils vs endoscopic ultrasonography. Eur Radiol. 2000; 10 653-660
- 22 Bokey EL, Öjerskog B, Chapuis PH. et al. . Local recurrence after curative excision of the rectum for cancer without adjuvant therapy : role of total anatomic dissection. Br J Surg. 1999; 86 1164-1170
- 23 Bonnen M, Crane C, Vauthey J-N. et al. . Long-term results using local excision after preoperative chemoradiation among selected T3 rectal cancer patients. Int J Radiation Oncol Biol Phys. 2004; 60 1098-1105
- 24 Borschitz T, Junginger T. Spezielle Aspekte des Vorgehens beim frühen Rektumkarzinom. Chir Gastroenterol. 2005; 21 137-144
- 25 Bosset JF, Magnin V, Maingon P. et al. . Preoperative radiochemotherapy in rectal cancer: long-term results of a phase II trial. Int J Radiat Oncol Biol Phys. 2000; 46 323-327
- 26 Bosset JF, Calais G, Mineur L. et al. . Enhanced tumorocidal effect of chemotherapy with preoperative radiotherapy for rectal cancer : preliminary results - EORTC 22921. J Clin Oncol. 2005; 23 5620-5627
- 27 Boulis-Wassif S, Gerard A, Loygue J. et al. . Final results of a randomised trial on the treatment of rectal cancer with preoperative radiotherapy alone or in combination with 5-fluorouracil, followed by radical surgery. Cancer. 1984; 53 1811-1818
- 28 Bourhis J, Lusinchi A, Eschwege F. The future of radiotherapy in rectal carcinoma. In: Bleiberg H, Kemeny N, Rougier P, Wilke H (eds.) Colorectal cancer. A clinical guide to therapy Martin Dunitz, London 2002: 257-261
- 29 Box B, Lindsey I, Wheeler JM. et al. . Neoadjuvant therapy for rectal cancer. Improved tumor response, local recurrence, and overall survival in non-anemic patients. Dis Colon Rect. 2005; 48 1130-1160
- 30 Bozzetti F, Andreola S, Baratti D. et al. . Preoperative chemoradiation in patients with resectable rectal cancer: results on tumor response. Ann Surg Oncol. 2002; 9 444-449
- 31 Branagan G, Chave H, Fuller C. et al. . Can magnetic resonance imaging predict circumferential margins and TNM stage in rectal cancer?. Dis Colon Rectum. 2004; 47 1317-1322
- 32 Brown CL, Tement CA, Thorson AG. et al. . Response to preoperative chemoradiation in stage II and III rectal cancer. Dis Colon Rect. 2003; 46 1189-1193
- 33 Brown G, Richards CJ, Newcombe RG. et al. . Rectal carcinoma: thin-section MR imaging for staging in 28 patients. Radiology. 1999; 211 215-222
- 34 Brown G, Radcliffe AG, Newcombe RG. et al. . Preoperative assessment of prognostic factors in rectal cancer using high-resolution magnetic resonance imaging. Br J Surg. 2003; 90 355-364
- 35 Brown G, Davies S, Williams GT. et al. . Effectiveness of preoperative staging in rectal cancer: digital rectal examination, endoluminal ultrasound or magnetic resonance imaging?. Br J. Cancer. 2004; 91 23-29
- 36 Brown G, Daniels IR. Preoperative staging of rectal cancer: the MERCURY research project. Recent Results Cancer Research. 2005; 105 58-74
- 37 Bülow S, Christensen IJ, Harling H. et al. . Recurrence and survival after mesorectal excision for rectal cancer. Br J Surg. 2003; 90 974-980
- 38 Bujko K, Nowacki MP, Nasierowska-Guttmejer A. et al. . Sphincter preservation following radiotherapy for rectal cancer: report of a randomised trial comparing short-term radiotherapy vs. conventionally fractionated radiochemotherapy. Radiother Oncol. 2004; 72 15-24
- 39 Burke SJ, Percarpio BA, Knight DC, Kwasnik EM. Combined preoperative radiation and mitomycin/5-fluorouracil treatment for locally advanced rectal adenocarcinoma. J Am Coll Surg. 1998; 187 164-170
- 40 Cammà C, Giunta M, Fiorica F. et al. . Preoperative radiotherapy for resectable rectal cancer: a meta-analysis. JAMA. 2000; 284 1008-1015
- 41 Carmody BJ, Otchy DP. Learning curve of transrectal ultrasound. Dis Colon Rectum. 2000; 43 193-197
- 42 Carraro S, Roca EL, Cartelli C. et al. . Radiochemotherapy with short daily infusion of low-dose oxaliplatin, leucovorin, and 5-FU in T3-4 unresectable rectal cancer: a phase II IATTGI study. Int J Radiation Oncol Biol Phys. 2002; 54 397-402
- 43 Cecil T, Sexton R, Moran BJ, Heald RJ. Total mesorectal excision results in low local recurrence rates in node positive rectal cancer. Dis Colon Rectum. 2004; 47 1145-1150
- 44 Civelli EM, Galliano G, Mariani L. et al. . Double-contrast barium enema and computerised tomography in the pre-operative evaluation of rectal carcinoma: are they still useful diagnostic procedures?. Tumori. 2000; 86 389-392
- 45 Chau AKP, Wong A, Jenken D. et al. . Posttreatment TNM staging is a prognostic indicator of survival and recurrence in tethered or fixed rectal carcinoma after preoperative chemotherapy and radiotherapy. Int J Radiation Oncol Biol Phys. 2005; 61 665-677
- 46 Chau I, Allen M, Cunningham D. et al. . Neoadjuvant systemic fluorouracil and mitomycin C prior to synchronous chemoradiation is an effective strategy in locally advanced rectal cancer. Brit J Cancer. 2003; 88 1017-1024
- 47 Chau I, Cunningham D, Tait D. et al. . Twelve weeks of neoadjuvant capecitabine and oxaliplatin followed by synchronous chemoradiation an total mesorectal excision in MRI defined poor risk locally advanced rectal cancer resulted in promising tumour regression and rapid symptomatic relief. Proc Am Soc Clin Oncol. 2003; 22 , abstract 1087
- 48 Chen C-C, Lee R-C, Lin J-K. et al. . How accurate is magnetic resonance imaging in restaging rectal cancer in patients receiving preoperative combined chemoradiotherapy?. Dis Colon Rect. 2005; 48 722-728
- 49 Chiesura-Corona M, Muzzio PC, Giust G. et al. . Rectal cancer: CT local staging with histopathologic correlation. Abdom Imaging. 2001; 26 134-138
- 50 Ciabattoni A, Cavallero A, Potenza AE. et al. . Preoperative concomitant radiochemotherapy with a 5-fluorouracil plus folinic acid bolus in the combined treatment of locally advanced extraperitoneal rectal cancer: a long-term analysis on 27 patients. Tumori. 2001; 89 157-163
- 51 Colombo PL, Foglieni CLS, Monroe C. Analysis of recurrence following curative low anterior resection and stapled anastomoses for carcinoma of the middle third and lower rectum. Dis Colon Rectum. 1987; 30 457-464
- 52 Colorectal Cancer Collaborative Group (CCCG) . Adjuvant radiotherapy for rectal cancer: a systematic review of 8507 patients from randomised trials. Lancet. 2001; 358 1291-1304
- 53 Compton CC. Pathologic prognostic factors in the recurrence of rectal cancer. Clin Colorect Cancer. 2002; 2 149-160
- 54 Dahlberg M, Glimelius B, Pahlman L. Changing strategy for rectal cancer is associated with improved outcome. Br J Surg. 1999; 86 379-384
- 55 Daniels IR, Moran BJ, Heald RJ. Surgery alone: is total mesorectal excision sufficient for rectal cancer?. In: Wiegel T, Höcht S, Sternemann M, Buhr HJ, Hinkelbein W (eds.). Controversies in gastrointestinal tumor therapy Karger, Basel 2004: 28-36
- 56 Dehni N, McFadden N, McNamara DA. et al. . Oncologic results following abdominoperineal resection for adenocarcinoma of the low rectum. Dis Colon Rect. 2003; 46 867-874
- 57 De la Torre A, Ramos S, Valcarcet FJ. et al. . Phase II study of radiochemotherapy with UPF and low-dose oral leucoverin in patients with unresectable rectal cancer. Int J Radiat Oncol Biol Phys. 1999; 95 629-634
- 58 Denecke T, Rau B, Hoffmann R-T. et al. . Comparison of CT, MRI and FDG-PET in response prediction of patients with locally advanced rectal cancer after multimodal preoperative therapy: is there a benefit in using functional imaging?. Eur Radiol. 2005; 15 1658-1666
- 59 Deutsche Krebsgesellschaft .Interdisziplinäre Leitlinien 1999. W. Zuckschwerdt München Bern Wien New York 1999: 125-126
-
60 Deutsche Krebsgesellschaft .(Informationszentrum für Standards in der Onkologie ISTO, Schmitt-Thomas BM. Hrsg.) (2002) Kurzgefasste interdisziplinäre Leitlinien 2002 3. Aufl. W. Zuckschwerdt, München Bern Wien New York; 178
- 61 Dixon AR, Maxwell WA, Thornton Homes J. Carcinoma of the rectum: a 10-year experience. Br J. Surg. 1991; 78 308-311
- 62 Dunst J, Reese T, Suttner T. et al. . Phase I trial evaluating the concurrent combination of radiotherapy and capecitabine in rectal cancer. J Clin Oncol. 2002; 30 3983-3991
- 63 Dzik-Jurasz A, Domenig C, George M. et al. . Diffusion MRI for prediction of response of rectal cancer to chemoradiation. Lancet. 2002; 360 307-308
- 64 Eu K-W, Seow-Chon F, Ho JMS. et al. . Local recurrence following rectal resection for cancer. J R Coll Surg Edinb. 1998; 43 393-396
- 65 Feliu J, Calvillo J, Escribano A. et al. . Neoadjuvant therapy of rectal carcinoma with UFT-leucovorin plus radiotherapy. Ann Oncol. 2002; 13 730-736
- 66 Fietkau R, Klautke G. Möglichkeiten und Entwicklungen der neoadjuvanten und adjuvanten Therapie des Rektumkarzinoms. Chir Gastroenterol. 2005; 21 119-129
- 67 Folprecht G, Grothey A, Alberts S. et al. . Neoadjuvant treatment of unresectable colorectal liver metastases: correlation between tumour response and resection rates. Ann Oncol. 2005; 16 1311-1319
- 68 Frykholm GJ, Glimelius B, Pahlmann L. Preoperative or postoperative irradiation in adenocarcinoma of the rectum: final treatment results of a randomized trial and an evaluation of late secondary effects. Dis Colon Rectum. 1993; 36 564-572
- 69 Gagliardi G, Bayar S, Smith R, Salem RR. Preoperative staging of rectal cancer using magnetic resonance imaging with external phase-arrayed coils. Arch Surg. 2002; 137 447-451
- 70 Gambacorta MA, Valentini V, Coco C. et al. . Chemoradiation with raltitrexed and oxaliplatin in preoperative treatment of stage II-III resectable rectal cancer: phase I and II studies. Int J Radiat Oncol Biol Phys. 2004; 60 139-148
- 71 Garcia-Aguilar J, Pollack J, Lee SH. et al. . Accuracy of endorectal ultrasonography in preoperative staging of rectal tumors. Dis Colon Rectum. 2002; 45 10-15
- 72 Garcia-Aguilar J, Hernandez de Anda E, Sirivongs P. et al. . A pathologic complete response to preoperative chemoradiation is associated with lower rectal recurrence and improved survival in rectal cancer patients treated by mesorectal excision. Dis Colon Rect. 2003; 46 298-304
- 73 George ML, Dzik-Jurasz AS, Padhani AR. et al. . Non-invasive methods of assessing angiogenesis and their value in predicting response to treatment in colorectal cancer. Br J Surg. 2001; 88 1628-1636
- 74 Gerard JP, Chapet U, Nemos C. et al. . Preoperative concurrent chemoradiotherapy in locally advanced rectal cancer with high-dose radiation and oxaliplatin-containing regime : the Lyon R0-04 phase II trial. J Clin Oncol. 2003a; 21 1119-1124
- 75 Gerard JP, Glynne-Jones R, Blackstock W. et al. . Radiochemotherapy in rectal cancer: the role of oxaliplatin. Colorect Dis. 2003b; 5 (Suppl 3) 29-35
- 76 Gerard JP, Ronestaing P, Chapet O, Baudieux J. Overview of the role of preoperative radiotherapy to increase sphincter preservation for rectal cancer. In: Wiegel T, Höcht S, Sternemann M, Buhr HJ, Hinkelbein W (eds) Controversies in gastrointestinal tumor therapy Karger, Basel 2004: 24-27
- 77 Gerard J-P, Chapet O, Nemoz C. et al. . Improves sphincter preservation in low rectal cancer with high-dose preoperative radiotherapy: the Lyon R96-02 randomized trial. J Clin Oncol. 2004; 22 2204-2209
- 78 Glimelius B. Role of radiotherapy in addition to optimal surgery. In: Soreide O, Norstein J (eds.). Rectal cancer surgery. Optimisation - standardisation - documentation Springer, Berlin Heidelberg New York 1997: 373-383
- 79 Glimelius B, Grönberg H, Järhult J. et al. . A systematic overview of radiation therapy effects in rectal cancer. Acta Oncol. 2003; 42 476-492
- 80 Glynne-Jones R, Sebag-Montefiore D. Rectal cancer: what can we learn from the Dutch TME study? How will this study impact on current practice in the U.K.? Clin Oncol. 2002; 14 170-173
- 81 Goh V, Halligan S, Bartram CI. Local radiological staging of rectal cancer. Clin Radiol. 2004; 59 215-226
- 82 Göhl J, Merkel S, Rödel C, Hohenberger W. Can neoadjuvant radiochemotherapy improve the results of multivisceral resections in advanced rectal carcinoma (cT4a)?. Colorect Dis. 2003; 5 436-441
- 83 Goethals L, Haustermans K, Perneel C. et al. . Chemoradiotherapy versus radiotherapy alone in the pre-operative treatment of resectable rectal cancer. Eur J Surg Oncol. 2005; 31 969-976
- 84 Grabbe E, Lierse W, Winkler R. The perirectal fascia: morphology and use in staging of rectal carcinoma. Radiol. 1983; 149 241-246
- 85 Graf W, Dahlberg M, Osman MM. et al. . Short-term preoperative radiotherapy results in down-staging of rectal cancer: a study of 1316 patients. Radiother Oncol. 1997; 43 133-137
- 86 Grann A, Feng C, Wong D. et al. . Preoperative combined modality therapy for clinically resectable uT3 rectal adenocarcinoma. Int J Radiat Oncol Biol Phys. 2001; 49 987-995
- 87 Gualdi GF, Casciani, E, Guadalaxara A. et al. . Local staging of rectal cancer with transrectal ultrasound and endorectal magnetic resonance imaging. Comparison with histologic findings. Dis Colon Rectum. 2000; 43 338-345
- 88 Guillem JG, Moore HG, Akhurst T. et al. . Prospective evaluation of the prognostic significance of FDG-PET assessment of rectal cancer response to preoperative chemoradiation. Proc Am Soc Clin Oncol. 2002; 21 145
- 89 Guillem JG, Chessin DB, Cohen AM. et al. . Long-term oncologic outcome following preoperative combined modality therapy and total mesorectal excision of locally advanced rectal cancer. Ann Surg. 2005; 241 829-834
- 90 Habr-Gama A, Perez RO, Nadalin W. et al. . Operative versus non-operative treatment for stage 0 distal rectal cancer following chemoradiation therapy. Long term results. Ann Surg. 2004; 240 711-718
- 91 Habr-Gama A, Perez RO, Kiss DR. et al. . Preoperative chemoradiation therapy for low rectal cancer: impact on downstaging and sphincter-saving operations. Hepatogastroenterology. 2004; 51 1703-1707
- 92 Hall NR, Finan PJ, Al-Jaberi T. et al. . Circumferential margin involvement after mesorectal excision of rectal cancer with curative intent. Predictor of survival but not local recurrence? Dis Colon Rectum. 1998; 41 979-983
- 93 Hartley A, Ho KF, McConkey C, Geh JI. Pathological complete response following pre-operative chemoradiotherapy in rectal cancer : analysis of phase II/III trials. Brit J Radiol. 2005; 78 934-938
- 94 Havenga K, Enker WE, Norstein J. et al. . Improved survival and local control after total mesorectal excision or D3 lymphadenectomy in the treatment of primary rectal cancer: an international analysis of 1411 patients. Eur J Surg Oncol. 1999; 25 368-374
- 95 Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery - the clue to pelvic recurrence?. Br J Surg. 1982; 69 613-616
- 96 Heidemann RM, Özsarlak O, Parizel PM. et al. . A brief review of parallel magnetic resonance imaging. Eur Radiol. 2003; 13 2323-2337
- 97 Henri M, Latulippe J-F, Heyen F, Dubé S. Complete pathologic response after chemoradiation for rectal cancer. Letter to the editor. Dis Colon Rect. 2005; 48 1097-1098
- 98 Hermanek P. What can the pathologist tell the surgeon about rectal cancer resection?. In: Scholefiled JH (ed). Challenges in colorectal cancer Blackwell Science, Oxford 2000: 80-90
- 99 Hermanek P, Hermanek PJ, Hohenberger W. et al. . The pathological assessment of mesorectal excision - implications for further treatment and quality assessment. Int J Colorect Dis. 2003; 18 335-341
- 100 Hermanek P, Heald RJ. Preoperative radiotherapy for rectum carcinoma?. Has the case really been made for short course preoperative radiotherapy if surgical standards for rectal carcinoma are optimal? Colorect Dis. 2004; 6 10-14
- 101 Hermanek P, Junginger Th. The circumferential resection margin in rectal carcinoma surgery. Tech Coloproctol. 2005; 9 193-200
- 102 Hershman MJ, Sun Myint A, Makin CA. Multi-modality approach in curative local treatment of early rectal carcinomas. Colorect Dis. 2003; 5 445-450
- 103 Hill GL, Rafique M. Extrafascial excision of the rectum for rectal cancer. Br J Surg. 1998; 85 809-812
- 104 Hiotis SP, Weber SM, Cohen AM. et al. . Assessing the predictive value of clinical complete response to neoadjuvant therapy for rectal cancer: an analysis of 488 patients. J Am Coll Surg. 2002; 194 131-136
- 105 Höcht S. Evaluating toxicity in neoadjuvant chemotherapy of rectal cancer. Int J Colorect Dis. 2003; 18 500-502
- 106 Hohenberger W. The effect of specialization or organization of rectal cancer surgery. In: Soreide O, Norstein J (eds.). Rectal cancer surgery. Optimisation - standardisation - documentation Springer, Berlin Heidelberg New York 1997: 353-363
- 107 Holm T. Complications of preoperative radiotherapy in rectal cancer. 2nd Biebrich Interdisciplinary Conference Colorectal Cancer. , Abstract 2003
- 108 Holm T, Johansson H, Cedermark B. et al. . Influence of hospital- and surgeon-related factors on outcome after treatment of rectal cancer with or without preoperative radiotherapy. Br J Surg. 1997; 84 657-663
- 109 Hughes R, Glynne-Jones R, Grainger J. et al. . Can pathological complete response in the primary tumour following preoperative chemoradiotherapy for T3-/4 rectal cancer predict for sterilization of pelvic lymph nodes, a low risk of local recurrence and the appropriateness of local excision?. Int J Colorect Dis. 2006; 21 11-17
- 110 Hünerbein M. Endorectal ultrasound in rectal cancer. Colorect Dis. 2003; 5 402-405
- 111 Hünerbein M, Pegios W, Rau B. et al. . Prospective comparison of endorectal ultrasound, three-dimensional endorectal ultrasound, and endorectal MRI in the preoperative evaluation of rectal tumors. Surg Endosc. 2000; 14 1005-1009
- 112 Hyams DM, Mamounas EP, Petrelli N. et al. . A clinical trial to evaluate the worth of preoperative multimodality therapy in patients with operable carcinoma of the rectum. A progress report of National Surgical Adjuvant Breast and Bowel Project Protocol R-03. Dis Colon Rect. 1997; 40 131-139
- 113 Jacob C, Aust DE, Meyer W. et al. . Thymidylate synthase, thymidine phosphorylase, dihydropyrimidine dehydrogenease expression, and histological tumor regression after 5-FU-based neo-adjuvant chemoradiotherapy in rectal cancer. J. Pathol. 2004; 204 562-568
- 114 Jacob C, Liersch T, Meyer W. et al. . Immunohistochemical analysis of thymidylate synthase, thymidine phosphorylase, and dihydropyrimidine dehydrogenase in rectal cancer (cUICC II/III). Correlation with histopathologic tumor regression after 5-fluorouracil-based long term neoadjuvant chemoradiotherapy. Am J. Surg Pathol. 2005; 29 1304-1309
- 115 Jatzko GR, Jagoditsch M, Lisborg PH. et al. . Long-term results of radical surgery for rectal cancer: multivariate analysis of prognostic influencing survival and local recurrence. Eur J Surg Oncol. 1999; 25 284-291
- 116 Junginger T, Hermanek P, Klimpfinger M. Klassifikation maligner Tumoren des Gastrointestinaltrakts I. Springer, Berlin Heidelberg New York 2002
- 117 Kallinowski B. Indications and effects on survival of standard chemotherapy in advanced colorectal cancer. Recent Results Cancer Research. 2005; 165 245-259
- 118 Kapiteijn E, Marijnen CA, Nagtegaal ID. et al. . Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. New Engl J Med. 2001; 345 638-646
- 119 Kienle P, Koch M, Autschbach F. et al. . Decreased detection rate of disseminated tumor cells of rectal cancer patients after preoperative chemoradiation. A first step towards a molecular surrogate marker for neoadjuvant treatment in colorectal cancer. Ann Surg. 2003; 238 324-331
- 120 Kim CJ, Yeatman TJ, Cappola D. et al. . Local excision of T2 and T3 rectal cancers after downstaging chemoradiation. Ann Surg. 2001; 234 352-359
- 121 Kim NK, Kim MJ, Yun SH. et al. . Comparative study of transrectal ultrasonography, pelvic computerized tomography, and magnetic resonance imaging in preoperative staging of rectal cancer. Dis Colon Rect. 1999; 42 770-775
- 122 Kim NK, Kim MJ, Park JK. et al. . Preoperative staging of rectal cancer with MRI, accuracy and usefulness. Ann Surg Oncol. 2000; 7 732-737
- 123 Kim D-W, Lim S-B, Kim DY. et al. . Pre-operative chemo-radiotherapy improves the sphincter preservation rate in patients with rectal cancer located within 3 cm of the anal verge. Eur J Surg Oncol. 2006; 32 163-167
- 124 Kirwan WO, O'Riordain MG, Waldron R. Declining indications for abdomino-perineal resection. Br J Surg. 1989; 76 1061-1063
- 125 Klautke G, Feyerherd P, Ludwig K. et al. . Intensified concurrent chemoradiotherapy with 5-fluorouracil and irinotecan as neoadjuvant treatment in patients with locally advanced rectal cancer. Br J Cancer. 2005; 92 1215-1220
- 126 Klump B, Nehls O, Okech T. et al. . Molecular lesions in colorectal cancer: impact on prognosis. Original data and review on literature. Int J Colorect Dis. 2004; 19 23-42
- 127 Knaebel H-P, Koch M, Feise T. et al. . Diagnostics of rectal cancer: endorectal ultrasound. Recent Results Cancer Research. 2005; 165 46-57
- 128 Köhne C-H. Stellenwert der intensivierten Chemotherapie und der neuen Substanzen in der adjuvanten und palliativen Situation beim kolorektalen Karzinom. Chir Gastroenterol. 2005; 21 145-150
- 129 Koh DM, Brown G, Temple L. et al. . Rectal cancer: mesorectal lymph nodes at MR imaging with USPIO versus histopathologic findings - initial observations. Radiology. 2004; 231 91-99
- 130 Kuo L-J, Chem M-C, Tsou M-H. et al. . Interpretation of magnetic resonance imaging for locally advanced rectal carcinoma after preoperative chemoradiation therapy. Dis Colon Rect. 2005; 48 25-28
- 131 Kuvshinoff B, Maghfoor I, Miedema B. et al. . Distal margin requirements after preoperative chemoradiotherapy for distal rectal carcinomas: are ≤1 cm distal margins sufficient?. Ann Surg Oncol. 2001; 8 163-169
- 132 Kwok H, Bissett LP, Hill GL. Preoperative staging of rectal cancer. Int J Colorect Dis. 2000; 15 9-20
- 133 Kwon H-C, Kim S-H, Roh M-S. et al. . Gene expression profiling in lymph node-positive and lymph node-negative colorectal cancer. Dis Colon Rectum. 2004; 47 141-152
- 134 Lehander Martling A, Holm T, Rutqvist L-E. et al. . Effect of a surgical training programme on outcome of rectal cancer in the County of Stockholm. Lancet. 2000; 356 93-96
- 135 Leonard GD, Brenner B, Kemeny NE. Neoadjuvant chemotherapy before liver resection for patients with unresectable liver metastases from colorectal carcinoma. J Clin Oncol. 2005; 23 2038-2048
- 136 Lezoche E, Guerrieri M, Paganini AM. et al. . Long-term results in patients with T2-3NO distal rectal cancer undergoing radiotherapy before transanal endoscopic microsurgery. Br J Surg. 2005; 92 1546-1552
- 137 Libutti SK, Tepper JE, Saltz LB, Rustgi AK. Cancer of the rectum. In: DeVita jr. VT, Hellman S, Rosenberg SA (eds.) Cancer. Principles & practice of oncology, 7th ed. Lippincott Williams & Wilkins, Philadelphia 2005: 1110-1125
- 138 Liersch T, Langer C, Jakob C. et al. . Präoperative Diagnostik beim lokal fortgeschrittenen Rektumkarzinom (≥T3 oder N+). Chirurg. 2003; 74 224-234
- 139 Luna-Pérez P, Bustos-Cholico E, Alvarado I. et al. . Prognostic significance of circumferential margin involvement in rectal adenocarinoma treated with preoperative chemoradiotherapy and low anterior resection. J Surg Oncol. 2005; 90 20-25
- 140 Mackay SG, Pager CK, Joseph D. et al. . Assessment of the accuracy of transrectal ultrasonography in anorectal neoplasia. Br J Surg. 2003; 90 346-350
- 141 Manger T, Stroh C. Accuracy of endorectal ultrasonography in the preoperative staging of rectal cancer. Tech Coloproctol. 2004; 8 S19-S15
- 142 Mannaerts GHH, Martijn H, Crommelin MA. et al. . Feasibility and first results of multimodality treatment combining EBRT, extensive surgery and IOERT in locally advanced primary rectal cancer. Int J Radiat Oncol Biol Phys. 2000; 47 425-433
- 143 Marijnen CAM, Nagtegaal ID, Kranenbarg EK. et al. . No downstaging after short-term preoperative radiotherapy in rectal cancer patients. J Clin Oncol. 2001; 19 1976-1984
- 144 Marijnen CAM, Glimelius B. The role of radiotherapy in rectal cancer. Eur J Cancer. 2002; 38 943-952
- 145 Marijnen CAM, Peeters KCMJ, Putter H. et al. . Long term results, toxicity and quality of life in the TME trial. Radiother Oncol. 2004; 73 127-128
- 146 Marr R, Birbeck K, Garvican J. et al. . The modern abdominoperineal excision : the next challenge after total mesorectal excision. Ann Surg. 2005; 242 74-82
- 147 Martling A, Holm T, Bremmer S. et al. . Prognostic value of preoperative magnetic resonance imaging of the pelvis in rectal cancer. Br J Surg. 2003; 90 1422-1426
- 148 Marusch F, Koch A, Schmidt U. et al. . Routine use of transrectal ultrasound in rectal carcinoma: results of a prospective multicenter study. Endoscopy. 2002; 34 385-390
- 149 Mathur P, Smith JJ, Rasey C. et al. . Comparison of CT and MRI in the preoperative staging of rectal adenocarcinoma and prediction of circumferential resection margin involvement by MRI. Colorect Dis. 2003; 5 396-401
- 150 Matsuoka H, Nakamura A, Masaki T. et al. . A prospective comparison between multidetector-row computed tomography and magnetic resonance imaging in the preoperative evaluation of rectal carcinoma. Amer J Surg. 2003; 185 556-559
- 151 Maugham NJ, Quirke P. Modern management of colorectal cancer - a pathologist's view. Scand J Surg. 2003; 92 11-19
- 152 Maurer CA, Renzulli P, Meyer JD, Büchler MW. Rektumkarzinom. Optimierung durch partielle oder totale Mesorektumentfernung. Zbl Chir. 1999; 124 428-435
- 153 Meade PG, Blatchford GJ, Thorson AG. et al. . Preoperative chemoradiation downstages locally advanced ultrasound-staged rectal cancer. Amer J Surg. 1995; 170 609-613
- 154 Medical Research Council (MRC) Rectal Cancer Working Party . Randomised trial of surgery alone vs. radiotherapy followed by surgery for potentially operable locally advanced rectal cancer. Lancet. 1996; 348 1605-1610
- 155 Mehta VK, Cho J, Ford JM. et al. . Radiotherapy, concomitant protracted-venous-infusion 5-fluorouracil, and surgery for ultrasound-staged T3 or T4 rectal cancer. Dis Colon Rect. 2001; 44 52-58
- 156 The MERCURY Study Group . Thin section magnetic resonance imaging predicts extramural depth of tumor invasion in patients with rectal cancer: results of the MERCURY study. Radiology. 2006; , (in press)
- 157 The MERCURY Study Group . Diagnostic accuracy of MRI in predicting surgical resection margin status: the focus of the rectal cancer multidisciplinary team preoperative discussion. Brit Med J. , (submitted) 2006;
- 158 Merkel S, Mansmann U, Siassi M. et al. . The prognostic inhomogeneity in pT3 rectal carcinomas. Int J Colorect Dis. 2001; 16 298-304
- 159 Meta-Analysis Group in Cancer . Reappraisal of hepatic arterial infusion in the treatment of non-resectable liver metastases from colorectal cancer. J Natl Cancer Inst. 1996; 88 252-258
- 160 Minsky BD. Adjuvant therapy for rectal cancer - the transatlantic view. Colorect Dis. 2003; 5 416-422
- 161 Minsky BD. Combined modality therapy of resectable rectal cancer: current approaches. Tech Coloproctol. 2004; 8 67-76
- 162 Minsky BD, Coia L, Haller D. et al. . Treatment systems guidelines for primary rectal cancer from the 1996 patterns of care study. Int J Radiat Oncol Biol Phys. 1998; 41 21-27
- 163 Mohiuddin M, Hayne M, Regine WF. et al. . Prognostic significance of postchemoradiation stage following preoperative chemotherapy and radiation for advanced/recurrent rectal cancer. Int J Radiat Oncol Biol Phys. 2000; 48 1075-1080
- 164 Moore HG, Gittleman AE, Minsky BD. et al. . Rate of pathologic complete response with increased interval between preoperative combined modality therapy and rectal cancer resection. Dis Colon Rectum. 2004; 47 279-286
- 165 Munro AJ, Bentley HM. Adjuvant radiotherapy in operable rectal cancer : a systematic review. Seminars Colon Rectal Surg. 2002; 13 31-42
- 166 Nesbakken A, Nygaard K, Westerheim O. et al. . Local recurrence after mesorectal excision for rectal cancer. Eur J Surg Oncol. 2002; 28 126-134
- 167 Ngan SY, Michael M., Mackay D.. et al. . A phase I trial of preoperative radiotherapy and capecitabine for locally advanced, potentially resectable rectal cancer. Br J Cancer. 2004; 91 1019-1024
- 168 Ngan SYK, Fisher R, Burmeister BH. et al. . Promising results of Cooperative Group phase II trial of preoperative chemoradiation for locally advanced rectal cancer (TROG 9801). Dis Colon Rect. 2005; 48 1389-1396
- 169 Nguyen NP, Sallah S, Karlsson U. et al. . Combined preoperative chemotherapy and radiation for locally advanced rectal carcinoma. Am J Clin Oncol. 2000; 23 442-448
- 170 Oberholzer K, Junginger T, Kreitner KF. et al. . Local staging of rectal carcinoma and assessment of the circumferential resection margin with high-resolution MR imaging using an integrated parallel acquisition technique. JMRI. 2005; 22 101-108
- 171 Onaitis MW, Noone RB, Hartwig M. et al. . Neoadjuvant chemoradiation for rectal cancer: analysis of clinical outcome from a 13-year institutional experience. Ann Surg. 2001; 233 778-785
- 172 Ota DM, Jacobs L, Kuvshinoff B. Rectal cancer: the sphincter-sparing approach. Surg Clin N Amer. 2002; 82 983-993
- 173 Pacelli F, Di Giorgio A, Papa V. et al. . Preoperative radiotherapy combined with intraoperative radiotherapy improve results of total mesorectal excision in patients with T3 rectal cancer. Dis Colon Rectum. 2004; 47 170-179
- 174 Pahlman L. Indications for long-term radiotherapy. In: Büchler MW, Heald RJ, Ulrich B, Weitz J (eds) Rectal cancer treatment. Recent results in cancer research, vol. 165 Springer, Berlin-Heidelberg, New York 2005: 212-220
- 175 Peeters KCMJ, van de Velde CJH, Leer JWH. et al. . Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: increased bowel dysfunction in irradiated patients - A Dutch Colorectal Cancer Group Study. J Clin Oncol. 2005; 23 6199-6206
- 176 Pucciarelli S, Toppan P, Friso ML. et al. . Complete pathologic response following preoperative chemoradiation therapy for middle to lower rectal cancer is not a prognostic factor for a better outcome. Dis Colon Rect. 2004; 47 1798-1807
- 177 Quirke P. Limitations of existing systems of staging for rectal cancer: the forgotten margin. In: Soreide O, Norstein J (eds.). Rectal cancer surgery. Optimisation - standardisation - documentation Springer, Berlin Heidelberg New York 1997: 63-81
- 178 Rau B, Hohenberger P, Gellermann J. et al. . T4-Rektumkarzinom. Operative und multimodale Therapie. Chirurg. 2002; 73 147-153
- 179 Read TE, Andujar JE, Caushaj PF. et al. . Neoadjuvant therapy for rectal cancer: histologic response of the primary tumor predicts nodal status. Dis Colon Rect. 2004; 47 825-831
- 180 Reerink O, Verschueren RCJ, Szabo RG. et al. . A favourable pathological stage after neoadjuvant radiochemotherapy in patients with initially irresectable rectal cancer correlates with a favourable prognosis. Eur J Cancer. 2003; 39 192-195
- 181 Reerink O, Karrenbeld A, Plukker JTM. et al. . Molecular prognostic factors in locally irresectable rectal cancer treated preoperatively by chemo-radiotherapy. Anticancer Research. 2004; 24 1217-1222
- 182 Rimkus C, Theisen J, Rosenberg R. et al. . Microarray-Genexpressionsanalysen zur Prädiktion der Response einer neoadjuvanten Radiochemotherapie bei lokal fortgeschrittenen Rektumkarzinomen. Langenbeck's Arch klin Chir, Chirurgisches Forum. 2005; 34 35-36
- 183 Rödel C, Grabenbauer GG, Papadopoulos T. et al. . Apoptosis as a cellular predictor for histopathologic response to neoadjuvant radiochemotherapy in patients with rectal cancer. Int J Radiat Oncol Biol Phys. 2002; 52 294-303
- 184 Rödel C, Grabenbauer GG, Papadopoulos T. et al. . Phase I/II trial of capecitabine, oxaliplatin, and radiation for rectal cancer. J Clin Oncol. 2003; 21 3098-3100
- 185 Rödel C, Sauer R. Neoadjuvant radiochemotherapy in rectal cancer: for which patients and tumor stages?. In: Wiegel T, Höcht S, Sternemann M et al. (eds.). Controversies in gastrointestinal tumor therapy Karger, Basel 2005: 13-23
- 186 Rödel F, Hoffmann J, Distel L. et al. . Survivin as a radioresistance factor and prognostic, and therapeutic target for radiotherapy in rectal cancer. Cancer Res. 2005; 65 1-7
- 187 Rouanet P, Saint-Aubert B, Lemanski C. et al. . Restorative and non-restorative surgery for low rectal cancer after high-dose radiation. Long-term oncologic and functional results. Dis Colon Rect. 2002; 45 305-315
- 188 Rullier E, Goffre B, Bonnel C. et al. . Preoperative radiochemotherapy and sphincter-saving resection for T3 carcinomas of the lower third of the rectum. Ann Surg. 2001; 234 633-640
- 189 Saltz LB, Minsky B. Adjuvant therapy of cancers of the colon and rectum. Surg Clin N Amer. 2002; 82 1035-1058
- 190 Sauer R, Fietkau R, Raab R, Wittekind Ch. Antwort auf C. A. Maurer und M. W. Büchler. Onkologe. 1997; 3 400-402
- 191 Sauer R, Becker H, Hohenberger W. et al. . Preoperative versus postoperative chemoradiotherapy for rectal cancer. New Eng J Med. 2004; 351 1731-1740
- 192 Schiepers C, Haustermans K, Geboes K. et al. . The effect of preoperative radiation therapy on glucose utilization and cell kinetics in patients with primary rectal carcinoma. Cancer. 1999; 85 803-811
- 193 Schlag PM, Burdach V. Neue prospektive Studie zur präoperativen Behandlung des Rektumkarzinoms. , Forum DKG 2004; 19/Heft 4: 8-9 und 31
- 194 Schmiegel W, Pox C, Adler G. et al. . S3-Leitlinienkonferenz „Kolorektales Karzinom”. Z Gastroenterol. 2004; 42 1129-1177
- 195 Scott N, Hale A, Deakin M. et al. . A histopathological assessment of the response of rectal adenocarcinoma to combination chemo-radiotherapy: relationship to apoptotic activity, p53 and bc1-2 expression. Eur J Surg Oncol. 1998; 24 169-173
- 196 Seong J, Cho JH, Kim NK. et al. . Preoperative chemoradiotherapy with oral doxifluridine plus low-dose oral leucovorin in unresectable primary rectal cancer. Int J Radiat Oncol Biol Phys. 2001; 50 435-439
- 197 Shibata D, Guillem JG, Lanouette N. et al. . Functional and quality-of-life outcomes in patients with rectal cancer after combined modality therapy, intraoperative radiation therapy, and sphincter preservation. Dis Colon Rect. 2000; 43 752-758
- 198 Simunovic M, Sexton R, Rempel E. et al. . Optimal preoperative assessment and surgery for rectal cancer may greatly limit the need for radiotherapy. Br J Surg. 2003; 90 999-1003
- 199 Smith FM, Reynolds JV, Miller N. et al. . Pathological and molecular predictors of the response of rectal cancer to neoadjuvant radiochemotherapy. Eur J Surg Oncol. 2006; 32 55-64
- 200 Spinelli P, Schiavo M, Meroni E. et al. . Results of EUS in detecting perirectal lymph node metastases of rectal cancer: the pathologist makes the difference. Gastrointest Endosc. 1999; 49 754-758
- 201 Steele SR, Martin MJ, Place RJ. Flexible endorectal ultrasound for predicting pathologic stage of rectal cancers. Am J Surg. 2002; 184 126-130
- 202 Stein DE, Mahmoud NN, Anné PR. et al. . Longer time interval between completion of neoadjuvant chemoradiation and surgical resection does not improve downstaging of rectal carcinoma. Dis Colon Rect. 2003; 46 448-453
- 203 Stryker SJ, Kiel KD, Rademaker A. et al. . Preoperative “chemoradiation” for stages II and III rectal carcinoma. Arch Surg. 1996; 131 514-519
- 204 Sutton AJ, Abrams KR, Jones DR. et al. .Methods for meta-analysis in medial research. John Wiley & Sons, New York 2000
- 205 Swedish Rectal Cancer Trial . Improved survival with preoperative radiotherapy in resectable rectal cancer. New Engl J Med. 1997; 336 980-987
- 206 Theodoropoulos G, Wise WE, Padmanat A. et al. . T-level downstaging and complete pathologic response after preoperative chemoradiation for advanced rectal cancer result in decreased recurrence and improved disease-free survival. Dis Colon Rectum. 2002; 45 895-903
- 207 Tjandra JJ, Kilkenny JW, Buie WD. et al. . Practice parameters for the management of rectal cancer (revised). Dis Colon Rect. 2005; 48 411-423
- 208 Tocchi A, Mazzoni G, Lepre L. et al. . Total mesorectal excision and low rectal anastomosis for the treatment of rectal cancer and prevention of pelvic recurrences. Arch Surg. 2001; 136 216-220
- 209 Treiber M, Oertel S, Weitz J. et al. . Intraoperative radiotherapy for rectal carcinoma. Recent Results Cancer Research. 2005; 165 238-244
- 210 Ueno H, Machizuki H, Hashiguchi Y. et al. . Preoperative parameters expanding the indication of sphincter preserving surgery in patients with advanced low rectal cancer. Ann Surg. 2004; 239 34-42
- 211 Valentini V, Coco C, Picciocchi A. et al. . Does downstaging predict improved outcome after preoperative chemoradiation for extraperitoneal locally advanced rectal cancer? A long-term analysis of 165 patients. Int J Radiat Oncol Biol Phys. 2002; 53 664-674
- 212 Vironen J, Juhola M, Kairaluoma M. et al. . Tumor regression grading in the evalution of tumor response after different preoperative radiotherapy treatments for rectal carcinoma. Int J Colorect Dis. 2005; 20 440-445
- 213 Volpe C, Rodriguez-Bigas M, Petrelli NJ. Wide perianal dissection and its effect on local recurrence following potentially curative abdominoperineal resection for rectal adenocarcinoma. Cancer Investigation. 1996; 14 1-5
- 214 Wheeler JMD, Dodds E, Warren BF. et al. . Preoperative chemoradiotherapy and total mesorectal excision surgery for locally advanced rectal cancer: correlation with rectal cancer regression grade. Dis Colon Rect. 2004; 47 2025-2031
- 215 Wibe A, Rendedal PR, Svensson E. et al. . Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer. Br J Surg. 2002; 89 327-334
- 216 Wichmann MW, Meyer G, Müller C. et al. . Immunologische Effekte der neoadjuvanten Radio-Chemotherapie beim lokal fortgeschrittenen Rektumkarzinom. Kongressband Dtsch Ges Chir. 2002; 467-468
- 217 Wiggers T, van de Velde CJH. Reduction “by half”. The need for standardized surgical technique in studies of radiotherapy for rectal cancer. Eur J Surg. 1999; 165 407-409
- 218 Williamson PR, Hellinger MD, Larach SW, Ferrara A. Endorectal ultrasound of T3 and T4 rectal cancers after preoperative chemoradiation. Dis Colon Rectum. 1996; 39 45-49
- 219 Zimmermann F, Molls M. Indikationen zur neoadjuvanten Therapie beim Rektumkarzinom. Chirurg. 2003; 74 887-896
- 220 Zmora O, Dasilva GM, Gurland B. et al. . Does rectal wall tumor eradication with preoperative chemoradiation permit a change in the operative strategy?. Dis Colon Rect. 2004; 47 1607-1612
Korrespondenzadresse
Prof. Dr. Th. Junginger
Direktor der Klinik und Poliklinik für Allgemein- und Abdominalchirurgie· Johannes Gutenberg-Universität Mainz
Langenbeckstr. 1·55131 Mainz
Phone: +49/6131/177291
Fax: +49/6131/176630
Email: sekretariat@ach.klinik.uni-mainz.de