Improved outcome following preoperative radiochemotherapy: 40.5 Gy accelerated hyperfractionation and 5-fluorouracil suppositories for patients with carcinoma of the lower rectum

Abstract

The aim of this study was to determine the long-term effects of administering preoperative radiochemotherapy to patients with carcinoma of the lower rectum. The outcomes of 29 patients who underwent curative surgery for carcinoma of the lower rectum after receiving radiochemotherapy in the form of 40.5 Gy accelerated hyperfractionation and a total dose of 3 400 mg 5-fluorouracil given as suppositories, with or without hyperthermia, and 48 patients who underwent surgery alone, were retrospectively compared. The tumors in all the patients were histologically diagnosed as stage T3. The cumulative 5-year survival rate and 5-year local recurrence-free rate of the patients treated with radiochemotherapy plus surgery were significantly better than those of the patients treated by surgery alone, the respective values being 80.5% vs 59.8% (P = 0.0325) and 95.7% vs 61.4% (P = 0.0041). Dehiscence of the perineal wound, anastomotic leakage, and postoperative ileus occurred at similar frequencies in both groups; however, perineal wound healing after abdominoperineal resection was delayed in the patients treated with radiochemotherapy plus surgery at 42.7 days vs 25.4 days (P = 0. 0062). In conclusion, although the wound healing was delayed, preoperative radiochemotherapy is considered to be beneficial for patients with carcinoma of the lower rectum.

Long-Term Results After Neoadjuvant Radiochemotherapy for Locally Advanced Resectable Extraperitoneal Rectal Cancer

“…The local recurrence rate was significantly lower in the irradiated group than in those who underwent surgery alone (11 vs. 23 percent, P < 0.001) and the same was evidenced regarding to overall five-year survival rate, which resulted of 58 percent in the combined treatment group and of 48 percent in the surgery alone group (P = 0.004). 9 Horie et al 13 published in 1999 the results of a retrospective series of 29 cases of T3 tumors of the lower rectum treated by radiochemotherapy and surgery compared with 48 cases with the same location and stage submitted to surgery alone. The median follow-up was 4.7 years for the first group and 4.9 years for the second.…”

“…Rullier et al 6 The few studies with longer follow-up period reported in literature seem to confirm the good oncologic results shown in more limited experiences. [13][14][15][16] In 1997, the Swedish Rectal Cancer Trial Group published the results of a prospective, multicenter, randomized trial aimed to compare radiotherapy and surgery and surgery alone in the treatment for rectal adenocarcinoma located below the promontory. The median follow-up for living patients was 75 months.…”

“…[1][2][3][4][5][6] Encouraging results also have been achieved in terms of recurrence rate 7,8 and survival, 9,10 even if in most of the published series the median follow-up period is too short to consider the results conclusive. [11][12][13][14] This study was designed to evaluate the long-term results of our series of 83 cases of locally advanced resectable extraperitoneal rectal cancer submitted to neoadjuvant radiochemotherapy between 1990 and 1995, on the base of a complete follow-up for the living patients of, at least, nine years.…”

Effects of Preoperative Conventional and Hyperfractionated Radiotherapy on the Healing of Rat Colonic Anastomoses

“…The authorsreportedsignificantlydecreasedburstingpressurecomparedtocontrols.Therewasamortalityrateof27%becauseof fractionatedradiotherapywhichrequiresdailyanesthesia.Our deathrateduetoanesthesiaandpulmonaryinfectionwasalso high.Horieetal. [18]showedsimilarratesofdehiscenceofthe perinealwound,anastomoticleakage,andpostoperativeileus between preoperative 40.5 Gy accelerated hyperfractionated irradiation and 5-fluorouracil versus surgery alone, although wound healing was delayed. Biert et al [26] observed the effectofasingleradiotherapydose(preoperative,intraoperative, postoperative)totheanastomosesonthe3rdand7thdayafter theoperation.Theyevaluatedanastomotichealingbyinspection,burstingpressure,hydroxyproline,andproteincontentsof theanastomoticsegment.Finally,theyreportedthatearlyhealingofratcolonicanastomosesisnotimpairedaftersingledoses of 20 or 25 Gy.…”

Postoperative Complications after Preoperative Chemoradiotherapy Combined with Hyperthermia in Locally Advanced Rectal Cancer

“…Horie et al 19) retrospectively compared the outcomes of 29 patients who underwent preoperative CCRT±HT followed by curative surgery for lower rectal cancer. A total dose of 40.5…”