Preoperative Radio-Chemotherapy Treatment in Locally Advanced Rectal Carcinoma. Results of 8-Year Follow-Up

Abstract

Background: Preoperative radio-chemotherapy (RCT) may play an important role in decreasing local recurrence and possibly improving survival for patients with advanced rectal carcinoma. Patients and Methods: Between 1995 and 1998 we treated 30 patients (pts) (median age 61.5 years) with advanced low rectal cancer. Radiotherapy was administered using a 10-MV linear accelerator delivering a total dose of 45 Gy to the pelvis over 5 weeks. 5-FU (500 mg/m2/d i.v.) was given concomitantly on days 1-3 and 29-31. Surgery was performed 2-4 weeks after RCT and included abdomino-perineal resection (APR) in 15 pts, anterior resection in 11 pts, transanal resection in 1 pt, and explorative laparotomy in 1 pt; 2 pts refused surgery. Results: There were no serious toxicities associated with RCT. Mild to moderate transient radiation dermatitis was noted in 3 pts, and grade II diarrhea in 4 pts. Postoperative pathologic staging was as follows: no tumor found (CR): 4 pts, MAC B1 (T2N0M0): 5 pts, MAC B2 (T3N0M0): 17 pts, B3 (vaginal involvement): 1 pt, MAC C2 (T3N1M0): 2 pts, and MAC D: 1 pt. Necrosis and/or fibrosis was noted as a prominent histopathologic feature. Conclusion: Preoperative RCT in this series of 30 pts with advanced rectal cancer was well tolerated and associated with a high response rate (13% CR, 17% PR, 57% NC). 5-year overall survival was 70%, and 8-year survival was 58%.

Multivisceral resections for locally advanced rectal cancer

“…Chemoradiotherapy (CRT) with surgery for locally advanced rectum cancer provides survival benefit. Given preoperatively CRT may reduce tumour size, facilitate resection with safe distal and lateral margins and increase the possibility of using a sphincter saving procedure [5–7].…”

Preoperative Staging of Rectal Tumors: Comparison of Endorectal Ultrasound, Hydro-CT, and High-Resolution Endorectal MRI

“…Preoperative treatment in primarily resectable tumors includes either short-term radiotherapy (5 × 5 Gy) or chemoradiation (5-fluorouracil (5-FU) and 45-50. 4 Gy radiotherapy) [5,6], which have been shown to significantly improve the local recurrence rate and overall survival [7]. The advent of transrectal ultrasound (TRUS), computed tomography (CT), and magnetic resonance imaging (MRI), in particular with the use of endorectal coils (ECMRI), has improved the preoperative staging of rectal carcinoma.…”

Concomitant Occurrence of Facial Cutaneous and Parotid Gland Metastases from Rectal Cancer after Preoperative Chemoradiotherapy

“…This is the first report, to our knowledge, of concomitant occurrence of facial cutaneous and parotid metastases from CRC. The present patient was subjected to preoperative Onkologie 2007;30: [324][325][326] Metastases to the Face and Parotid Gland from CRC chemoradiotherapy that only recently has become a standard treatment for CRC [1][2][3]. In relation to this, there have been recent reports of a case of facial metastasis from CRC in a patient preoperatively treated with radiotherapy [8] and another of unusual parotid involvement in breast cancer after radiotherapy [9].…”

“…Therefore, preoperative chemoradiotherapy, as compared with postoperative chemoradiotherapy improved local control with reduced treatment-related side effects [2]. Recently, it was also described that preoperative radiochemotherapy in a series of patients with advanced rectal cancer was well tolerated and associated with a high response rate (13% complete remission (CR), 17% partial remission (PR), 57% no change (NC)) with a 5-year overall survival of 70%, and 8-year survival of 58% [3]. Unusual sites of metastasis to the parotid gland and face are reported in patients with colorectal cancer (CRC), but, at least to our knowledge, the localization to both sites at the same time has never been described before [4][5][6][7][8].…”