TME-Totale Mesorectale Exicisie met bestraling vooraf leidt tot significant grotere niet aan kanker gerelateerde sterfte binnen 6 maanden na TME bij oudere patienten (>75 jaar) met rectumkanker.

17 september 2018: lees ook het ervaringsverhaal van meneer Cor C.

Lees ook:

https://kanker-actueel.nl/studiepublicaties-van-niet-toxische-middelen-en-behandelingen-uit-literatuurlijst-van-arts-bioloog-drs-engelbert-valstar-gerelateerd-aan-vormen-van-darmkanker.html

27 april 2018: lees ook dit artikel:

https://kanker-actueel.nl/verkorte-radiotherapie-vooraf-aan-operatie-tme-bij-lokaal-uitgezaaide-rectumkanker-geeft-beduidend-minder-complete-remissies-in-vergelijking-met-volledige-chemoradiotherapie-vooraf-aan-operatie.html

11 november 2011: klik hier voor de meest recente studie naar effecten van bestraling en chemo vooraf aan operatie op die operatie zelf bij patienten met niet uitgezaaide rectumkanker - endeldarmkanker volgens recente Nederlandse studie

5 mei 2008: Bron: 1: Lancet Oncol. 2008 May;9(5):494-501.en 1: Eur J Cancer. 2007 Oct;43(15):2295-300. Epub 2007 Aug 20. Click here to read

Twee Nederlandse studies tonen aan dat TME - Total Mesorectal Excision bij patienten met rectumkanker en ouder dan 75 jaar niet zinvol is. In tegendeel uit een grote overzichtstudie van voor en na de introductie van TME blijkt dat patienten ouder dan 75 jaar binnen 6 maanden na de TME overlijden aan de bijwerkingen van TME en niet aan hun kanker. Voor patienten jonger dan 75 jaar is TME wel zinvol. Hoe de onderzoekers aan de leeftijd van 75 jaar komen zal vermoeden wij een gemiddelde zijn. Zie onderstaande abstracten met een mogelijkheid om ook het volledige studierapport te lezen. Alles in het Engels helaas maar indien u of een van uw naasten in aanmerking komt voor TME neem dan ook deze abstracten mee naar uw oncoloog. Of laat hem/haar contact opnemen met de Nederlandse onderzoekers. BV. Dr. Harm Rutten: harm.rutten@cze.nl

Survival of elderly rectal cancer patients not improved: analysis of population based data on the impact of TME surgery.

Rutten H, den Dulk M, Lemmens V, Nieuwenhuijzen G, Krijnen P, Jansen-Landheer M, van de Poll Franse L, Coebergh JW, Martijn H, Marijnen C, van de Velde C.

Department of Surgery, Catharina Hospital, Michelangelolaan 2, PO Box 1350, 5623 ZA Eindhoven, The Netherlands. harm.rutten@cze.nl <harm.rutten@cze.nl>

INTRODUCTION: The incidence of rectal cancer is highest in elderly patients. However, these patients are often underrepresented in randomised studies. Therefore, it is not clear whether results of rectal cancer studies are equally applicable to both elderly and younger patients. In this paper, the Dutch Total Mesorectal Excision (TME) study is revisited, focused on patients aged 75 years and above. The rectal cancer databases of the Comprehensive Cancer Centres (CCC) South and West were combined to analyse the effect of the TME-study in three different periods: before (1990-1995), during (1996-1999) and after (2000-2002) the trial.

RESULTS: Implementation of preoperative radiotherapy, as investigated in the TME trial, and the introduction of TME surgery resulted in improved 5 year survival during the subsequent periods, in patients younger than 75 years, of 60% (1990-1995) to 67% (1996-1999) and 70% (2000-2002) (log rank p<0.0001). The older patients did not improve and remained at 41%, 40% and 43% at 5 years in the respective periods. Furthermore, mortality during the first 6-month period after treatment is significantly raised compared to younger patients: 14% in the elderly, compared to 3.9% in the younger TME-study patient (p<0.0001 X2). In the CCC database these figures were confirmed at 16% and 3.9% (p<0.0001 X2).

CONCLUSION: Overall survival was not improved in the elderly rectal cancer patient after introduction of preoperative radiotherapy and TME-surgery. Non-cancer related mortality is a significant problem in the first 6 months after surgery.

PMID: 17709242 [PubMed - indexed for MEDLINE]

1: Lancet Oncol. 2008 May;9(5):494-501.

Controversies of total mesorectal excision for rectal cancer in elderly patients.

Rutten HJ, den Dulk M, Lemmens VE, van de Velde CJ, Marijnen CA.

Department of Surgery, Catharina Hospital, Eindhoven, Netherlands. harm.rutten@cze.nl

The cornerstone of treatment for rectal cancer is resectional treatment according to the principles of total mesorectal excision (TME). However, population-based registries show that improvements in outcome after resectional treatment occur mainly in younger patients. Furthermore, 6-month postoperative mortality is significantly increased in elderly patients (> or = 75 years of age) compared with younger patients (< 75 years of age). Several confounding factors, such as treatment-related complications and comorbidity, are thought to be responsible for these disappointing findings. Thus, major resectional treatment is not advantageous for all older patients with rectal cancer. However, the Dutch TME trial showed a good response to a short course of neoadjuvant radiotherapy in elderly patients. Biological responses to cancer treatment seem to change with age, and, therefore, individualised cancer treatments should be used that take into account the heterogeneity of ageing. For elderly patients who retain a good physical and mental condition, treatment that is given to younger patients is deemed appropriate, whereas for those with diminished physiological reserves and comorbid conditions, alternative treatments that keep surgical trauma to a minimum and optimise the use of radiotherapy might be more suitable.

PMID: 18452860 [PubMed - in process]

rectumkanker, endeldarmkanker, oudere mensen, bejaarden, TME