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Pembimbing
Pembimbing :: dr.
dr. Bambang
Bambang sugeng,
sugeng, sp. b
Writers
Writers : David Sebag-Montefi ore, Richard J Stephens, Robert Steele,
John
John Monson,
Monson, Robert
Robert Grieve,
Grieve, Subhash Khanna,
Khanna, Phil
Phil Quirke,
Quirke, Jean
Jean
Couture,
Couture, Catherine
Catherine de Metz, Arthur Sun Myint, Eric Bessell, Gareth
Griffi
Griffi ths,
ths, Lindsay
Lindsay CC Thompson,
Thompson, Mahesh
Mahesh Parmar,
Parmar, on
on behalf
behalf of
of all
all the
the
trial
trial collaborators*
collaborators*
Published
Published date : March
March 2009
2009
Published
Published by : The Lancet of Oncology
BACKGROUND
Randomised controlled trials published before
1998 showed a high rate of local recurrence after surgery
Alone Loco-regional recurrence after resection of rectal cancer is
difficult to treat and is associated with severe debilitating
symptoms. The prognosis after a local recurrence is
poor, with a median survival of 1218 months
This approach was already in clinical use in the UK at the time that the
trial was launched.
AA further
further trial
trial has
has shown
shown aa significant
significant reduction
reduction in
in both
both local
local recurrence
recurrence
and
and late
late toxic
toxic eff
eff ects
ects in
in favour
favour of
of preoperativechemoradiotherapy
preoperativechemoradiotherapy
compared
compared with
with postoperativechemoradiotherapy.
postoperativechemoradiotherapy.
This
This finding
finding has
has affected
affected the
the US
US policy
policy of
of postoperative
postoperative chemoradiotherapy,
chemoradiotherapy,
with
with aa shift
shift to
to the
the use
use of
of preoperative
preoperative chemoradiotherapy
chemoradiotherapy in in selected
selected
patients.
patients. These
These results
results suggest
suggest that
that aa direct
direct comparison
comparison of
of short-course
short-course
preoperative
preoperative radiotherapy
radiotherapy and
and preoperative
preoperative chemoradiotherapy
chemoradiotherapy is is needed.
needed.
CRITICAL APPRAISAL
Abstrak
Consisted of 4 paraghraphs
Components : background, methods,findings, and interpretations
More than 250 words 328 words
No keywords mentioned
PRIMARY OUTCOME
Local Recurence 27 preoperative
radiotherapy vs 72
selectivepostoperative
Chemoradiotherapy
a reduction of 61% in the
relative risk of local
recurrence for patients
receiving preoperative
radiotherapy (hazard
ratio [HR] 039, 95% CI
027058, p<00001)
SECONDARY OUTCOME
Overall Survival Overall survival did not diff er between the
groups (HR 091, 95% CI 073113, p=040)
Disease Free Survival a relative improvement in disease-free survival
of 24% for patients receiving preoperative
radiotherapy (HR 076, 95% CI 062094,
p=0013)
Local Reccurence-Free Survival Comparison of the Kaplan-Meier curves (fi gure
2A) gives an HR of 039 (95% CI 027058;
p<00001), indicating a 61% relative reduction
in the risk of recurrence with preoperative
radiotherapy.
Post Operative Morbidity 147 disease-related events were recorded in
the preoperative radiotherapy group and 189 in
the selective postoperative chemoradiotherapy
group.
APPLICABLE