Radio-Chemotherapy as a Preoperative Treatment for Advanced Rectal Cancer. Evaluation of Down-Staging and Morbidity

Abstract

Background: The standard therapy for patients with clinically resectable rectal cancer is generally considered to be surgery. If the patient is diagnosed with advanced disease, postoperative radio-chemotherapy (RCT) is usually recommended. In our study we aimed to investigate and analyze the effectiveness and toxicity of preoperative pelvic radiotherapy in combination with 5-fluorouracil (5-FU) in locally advanced rectal cancer. Patients and Methods: From June 1999 to September 2001 we evaluated 50 consecutive patients [37 male and 13 female; average age 65.1 (range 46–79.5) years] with locally advanced rectal carcinoma. 32 patients were staged as uT3, 14 as uT4, and 4 as uT2. Regarding N-staging, 22 patients were diagnosed as uN0. 2 patients had distant metastases, with liver metastases in both instances. Conformal irradiation was performed with a box technique (4-field technique) with a dose of 45 Gy (5 × 1.8 Gy per week for a total of 25 sessions). From days 1–5 and 29–33, all patients received 5-FU (500 mg/m² per day, as a continuous i.v. injection). Results: Remission was observed in 28 patients (56%), with down-staging of at least one T-stage. A better success rate was achieved for patients with deep-seated tumors (64% of the patients in this group). Complete remission was observed in 4 patients (8.0%) and progression in 3 (6.0%). 15 patients had no detectable change in tumor staging (30.0%). A surgical R0 resection could be achieved in 43 patients, an R1 resection (minimal margin) in 7. Side effects and toxicity (common toxicity criteria) of RCT included grade I-II dysuria in 5 patients (10%), grade I-II diarrhea in 20 patients (40%), and severe diarrhea in 2 patients (4.0%). Grade I-II skin reaction was noticed in 22 patients (44.0%), severe skin reaction only in 1 patient. Regarding acute postoperative morbidity, abscess and fistula formation was noted in 8 patients (16.0%), with anastomosis leakage in 7 (14%). Conclusion: Preoperative radiotherapy appears to be a feasible therapeutic approach with moderate toxicity and the potential to induce down-staging. The data presented in this study confirm the preliminary reports on this neoadjuvant treatment.

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

“…The short interval between preoperative radiochemoterapy and surgery in our study is associated with lower tumor response rate 30% (CR: 13% and PR: 17%) in comparison to the long interval reported by other authors: 71.7% [8], and 64% [6]. In most of the patients the stage of disease was without change (57%), however, M. Schaffer reported only 30% of patients without change [6]. We now report a 5-year actuarial local failure rate of 10% and a 5-year overall survival of 70%, and 8-year survival of 58%.…”

“…In this update of 30 patients the pathologic CR rate decreased to 13% and is similar to results of R90-01 trial in the SI group 10.3%. The short interval between preoperative radiochemoterapy and surgery in our study is associated with lower tumor response rate 30% (CR: 13% and PR: 17%) in comparison to the long interval reported by other authors: 71.7% [8], and 64% [6]. In most of the patients the stage of disease was without change (57%), however, M. Schaffer reported only 30% of patients without change [6].…”

“…Over the past decades preoperative radiotherapy is becoming the standard of care for resectable, locally advanced rectal cancer. Different combinations of preoperative radiochemotherapy are used for downstaging, sphincter preservation, local control, and improving survival [3][4][5][6]. We retrospectively analyzed the effectiveness and toxicity of preoperative pelvic radiotherapy in combination with 5-fluorouracil (5-FU) in locally advanced rectal cancer.…”

Impact of Upward Lymph Node Dissection on Survival Rates in Advanced Lower Rectal Carcinoma

“…However, in Western countries, the survival benefits of lateral pelvic lymph node dissection are regarded as doubtful. Instead, preoperative chemoradiotherapy is widely performed [18, 19]. To resolve this disparity, a multicentric randomized clinical trial that compares lateral pelvic lymph node dissection with autonomic nerve preservation to total mesenteric excision (JCOG-0212) is underway in Japan and data regarding this issue will become available in the near future [20].…”

Safety and efficacy of high‐dose chemotherapy with autologous stem cell transplantation for patients with malignant astrocytomas

“…The use of neoadjuvant chemotherapy before surgery or radiotherapy has shown great promise in the treatment of a number of carcinomas, including rectal, [35][36][37] breast, 38,39 and head and neck carcinomas. 40,41 For these patients, neoadjuvant chemotherapy leads to easier and complete surgical resection with improved survival and quality of life.…”