Influence of neoadjuvant treatment of rectal carcinoma on operability and incidence of distant metastases

Abstract

Abstract:In the Czech Republic, rectal carcinoma does not only represent a medical problem, but also a socioeconomic one. At our department, we treated totally 266 patients with rectal carcinoma in the years 1998 through 2006. Among our patients, neoadjuvant treatment led to a reduction in size of the tumour in 37.6 %, in 50.8 % the size did not change. In T3 tumours, the reduction in size was observed in 36.7 % of the patients and did not change in 56 %; in T4 tumours, the reduction in size was observed in 60% of the patients. In 88 % of the patients who underwent the operation, no residual tumour was found, in 9 % of patients, a residual tumour was detected. In 19 % of the patients, a local recurrence of the tumour was detected. A statistically signifi cant relationship was proved between the appearance of the metastatic disease and the presence of angioinvasion and the size of the primary tumour according to the Duke's classifi cation (Tab. 1, Fig. 4, Ref. 20 In the Czech Republic, the incidence rate of rectal carcinoma has recently reached 20.7 per 100 000 population and mortality rate has reached 10.1 per 100 000 population (data from the year 2007). The incidence increases steeply from 50 years of age. The Czech Republic is ranked among the countries with the highest incidence of this disease. According to the latest Czech population data from the year 2007, the proportions of the stages of rectal carcinoma is as follows: stage I. 22.9 %, stage II 20.4 %, stage III 24.1 %, stage IV 21.7 % and 10.9 % of newly diagnosed cases are unstaged mostly due to objective reasons, like a very advanced disease, early death, patient's refusal of anti-tumour therapy, generally poor health status of a patent, etc.. Surgical approach is the basis of therapy for the clinical stages II and III. In contrary to the early stage I, enough evidence from clinical studies has been collected over the last decade to support a treatment strategy combining chemotherapy and radiotherapy for the stages II and III. These studies were inspired by the frequent appearance of local relapses but also distant metastases in patients treated solely surgically. The results of these studies had clearly shown that a combined therapeutic approach leads to a signifi cantly lower incidence of relapses (1-4).The goal of our retrospective analysis is to ascertain the effect of neoadjuvant treatment on the reduction of size of the primary tumour, achieving operability and affecting the incidence of early generalization of the disease. Patients and methodsIn the period 1998-2006, we treated at our department totally 266 patients diagnosed with rectal carcinoma. 102 of the patients were females, with the median age of 64 years (ranging 29-89 years); 164 were males with the median age of 60 years (ranging 26-84 years) (Fig. 1). 6 % of the tumours were of the stage T2, 82 % stage T3 and 11 % stage T4; in 1 % of the patients the tumour stage was undeterminable. The proportion of the clinical stages I, II, III, and IV were 5.6 %, 72.2 %, 14.7 %, and 2.3 % respe...