1. MRC CR07: 5x5 TME vs. TME RCT in CRM+ @ 3y Preop. RT + OP (n=674)
OP + RCT in CRM + (n=676)
Hazard- Ratio (95%CI)
Local recurence
4.7%
11.1%
2.5 ( )
Disease free survival
79.5%
74.9%
1.31 ( )
Overall survival
80.8%
78.7%
1.25 ( )
Sebag-Montefiore et al., ASCO 2006

2. CAO/ARO/AIO-94 R Sauer et al. N Eng J Med 2004 (4 cycles) TME
823 patients
Primary endpoint: overall survival
Local recurrence rate
Sauer et al. N Eng J Med 2004

3. FFCD 9203 R Gerard et al. J Clin Oncol 2006, ASCO 2005 TME not routine
(4 Zyklen) R S
(4 Zyklen)
733 patients
TME not routine
Local recurrence rate
Primary endpoint: overall survival
Gerard et al. J Clin Oncol 2006, ASCO 2005

4. Primary endpoint: overall survival
EORTC 22921 S
(4 cycles) S
(4 cycles) R S
1011 patients
100 S 90 80 70
Adj CT 60 50
5-year OS (95%CI)
63.2 (58.3, 68.1)
67.2 (62.7, 71.8) 40
No Adj CT 30 20 10
Adj. CT vs no Adj CT: p=0.1187
(years) 2 4 6 8 10 12
Primary endpoint: overall survival
Bosset et al. N Eng J Med 2006

5. Disease free survival @ 5 yrs.
EORTC Study: Role of adjuvant Chemotherapy
Disease free 5 yrs.
Overall 5 yrs.
Bosset et al., NEJM 2006

6. EORTC 22921 R TME in 37% Bosset et al. N Eng J Med 2006 (4 cycles) S S
1011 patients S
TME in 37%
Lokal recurrence rate
Bosset et al. N Eng J Med 2006

7. EORTC-Studie 22921 Rolle der adjuvanten Chemotherapie
Collette, J Clin Oncol 2007

8. PreOP trials: Patterns of failure
local failure
vs.
distant mets.
5y OS
FFCD JCO 2006
RT vs. RChT
16% %
36% %
66% %
EORTC NEJM 2006
17% %
32% %
65% %
AIO/CAO/ARO NEJM 2004
Pre vs. post
13% %
74% %*
Marijnen ASCO GI 2005
5x5
11% %
n.a.
63% %
Despite significant reduction of local relapse,
no influence on distant mets. and survival observed

9. Improvement of chemorad ?
Improvement of adjuvant Chemotherapy!