Morton, NEJM 2006

Groups:

·       wide excision with SLNB (biopsy)

·       wide excision and observation of regional nodal basin (obs)

o   underwent delayed lymphadenectomy if nodal recurrences became clinically detectable

·       It’s an interim analysis of a multi-centre study comparing SLNB with clinical observation (q3 months) of the regional drainage basin.

·       Basically, the point is, SLNB good, observation bad because once these patients develop clinically evident disease, therapeutic resection at that point carries a higher mortality.

Link:

Long course neoadjuvant chemoRT for rectal cancer

Sauer et. al., NEJM 2004 - Pre-op vs Post-op ChemoRT for Rectal ca
- no difference in overall survival but improved local recurrence rate
in pts with long course therapy.

Protocol:
- Radiation 5d per week for five weeks
- continuous 5-FU infusion during weeks 1 and 5.
- surgery performed within 6 weeks of completion of therapy
- decreases local recurrence from 13% to 6% in T3, T4 or N1 disease compared to postoperative adjuvant therapy.
- there was also a decrease in treatment toxicity (40% vs 27%) compared to postoperative adjuvant therapy.
- But no difference in overall survival.