Survival following moderate-dose preoperative radiation therapy for carcinoma of the rectum

Abstract

We performed a retrospective study of patients with carcinoma of the rectum or rectosigmoid undergoing surgical resection. Forty‐two patients received adjuvant preoperative radiation therapy (4000–4500 rad). One hundred twenty patients underwent surgical resection alone. Survival of radiation patients was significantly improved over that of Surgery Only patients, even after adjusting for nontreatment factors using Cox regression. Crude 5‐year survival was 63% for radiation patients (74% adjusted) compared to 46% for surgery‐only patients (48% adjusted) (P < 0.025). Radiation patients also had longer disease‐free survival than surgery‐only patients (P < 0.05) and fewer recurrences (14% versus 37%; P < 0.025). Fewer radiation patients had lymph nodes involved with tumor than surgery‐only patients (20% versus 35%; P = 0.07). Although 71% of radiation patients experienced radiation reactions, these were primarily mild and transitory. We believe that preoperative radiation is an effective and safe adjunct to surgery in the treatment of rectal cancer and that its use can lead to improved survival rates.

Conformal Preoperative Endorectal Brachytherapy Treatment for Locally Advanced Rectal Cancer

“…The comparative pathologic tumor down-staging results reported in the literature range from 2 to 14 [18][19][20][21][22][23] (mean, 7) percent for external beam radiotherapy and from 4 to 32 (mean, 14) percent for external beam with chemotherapy. [24][25][26][27][28][29][30][31] High dose-rate brachytherapy is significantly more effective at tumor downstaging and downsizing than external beam alone or with chemotherapy.…”

Neoadjuvant Chemoradiation Increases the Risk of Pelvic Sepsis After Radical Excision of Rectal Cancer

“…[21][22][23][24][25]31 However, this may be an underestimation of the consequences of neoadjuvant therapy on rectal cancer surgery. Some of these studies have shown a trend toward increased risk of pelvic septic complications 25,26 and perineal wound complications.…”

“…Several studies have not demonstrated a statistically significant increased risk of perioperative complications after short-course preoperative radiation, 22 long course preoperative radiation, 23,24 or chemoradiation. 25 However, a number of other studies have shown a trend toward increased risk of pelvic septic complications 25,26 and perineal wound complications.…”

Predictive value of Smac, VEGF and Ki-67 in rectal cancer treated with neoadjuvant therapy

“…Pre-operative CRT for locally advanced rectal cancer has several potential advantages, including a decrease in tumor volumes, introduction of downstaging, an increase in the possibility of R0 resection, a reduction in radiation-induced toxicity, enhanced probability of anal sphincter preservation by shrinking large distal tumors, a reduction in local recurrence and improvement in survival (6)(7)(8)(9)(10). However, the response of individual tumors to adjuvant therapies is not uniform.…”