Neoadjuvant Chemoradiation for Rectal Cancer: Analysis of Clinical Outcomes From a 13-Year Institutional Experience

Abstract

ObjectiveTo examine clinical outcomes in patients receiving neoadjuvant chemoradiation for locally advanced rectal adenocarcinoma. Summary Background DataPreoperative radiation therapy, either alone or in combination with 5-fluorouracil-based chemotherapy, has proven both safe and effective in the treatment of rectal cancer. However, data are lacking regarding which subgroups of patients benefit from the therapy in terms of decreased local recurrence and increased survival rates. MethodsA retrospective chart review was performed on 141 consecutive patients who received neoadjuvant chemoradiation (5-fluorouracil Ϯ cisplatin and 4,500 -5,040 cGy) for biopsyproven locally advanced adenocarcinoma of the rectum. Surgery was performed 4 to 8 weeks after completion of chemoradiation. Standard statistical methods were used to analyze recurrence and survival. ResultsMedian follow-up was 27 months, and mean age was 59 years (range 28 -81). Mean tumor distance from the anal verge was 6 cm (range 1-15). Of those staged before surgery with endorectal ultrasound or magnetic resonance imaging, 57% of stage II patients and 82% of stage III patients were downstaged. The chemotherapeutic regimens were well tolerated, and resections were performed on 140 patients. The percentage of sphincter-sparing procedures increased from 20% before 1996 to 76% after 1996. On pathologic analysis, 24% of specimens were T0. However, postoperative pathologic T stage had no effect on either recurrence or survival. Positive lymph node status predicted increased local recurrence and decreased survival. ConclusionsNeoadjuvant chemoradiation is safe, effective, and well tolerated. Postoperative lymph node status is the only independent predictor of recurrence and survival.

Neoadjuvant systemic fluorouracil and mitomycin C prior to synchronous chemoradiation is an effective strategy in locally advanced rectal cancer

“…In our study, over 40% of patients had T4 tumours representing a group of patients with truly locally advanced disease. This may account for the low pathological complete response rate seen in our study compared with 10 -30% achieved in other studies (Janjan et al, 1999;Bosset et al, 2000;Chan et al, 2000;Grann et al, 2001;Onaitis et al, 2001;Valentini et al, 2001). Two studies included only patients with clinically staged T4 tumours (Videtic et al, 1998;Rodel et al, 2000).…”

“…Many recent studies included T3 tumours staged by endoscopic ultrasound which are often less bulky than clinically staged T3 tumours. Very few patients with T4 tumours were recruited (o5% of total enrolled) in these studies (Janjan et al, 1999;Bosset et al, 2000;Chan et al, 2000;Grann et al, 2001;Onaitis et al, 2001;Valentini et al, 2001). In our study, over 40% of patients had T4 tumours representing a group of patients with truly locally advanced disease.…”

Pathologic response to neoadjuvant treatment in locally advanced rectal cancer and impact on outcome

“…pCR rates following preoperative CRT are shown in a body of research literature to range from 9% to 30% (1,2,7,8,10,11,15,16) while some studies report a partial response to neoadjuvant treatment of 51% (6,11). The correlation between response to neoadjuvant treatment and oncologic outcome has been reported in other studies (3,4,(6)(7)(8)(9)(10)(11)(12)(17)(18)(19)(20)(21)(22)(23).…”

Cost Analysis of Early versus Delayed Loop Ileostomy Closure: A Case-Matched Study

“…Neoadjuvant treatment can lead to a significant downstaging of colorectal tumours and this may in part explain the difference in T stage between groups [36,37]. Nevertheless two randomised trials have shown that preoperative chemoradiotherapy does not increase postoperative complications.…”