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Pre-operative radiochemotherapy of locally advanced rectal cancer
Xiao-Nan Sun1, Qi-Chu Yang, Jian-Bin Hu
1Department of Radiation Oncology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China. sunxiaonan@hotmail.com
Aim:
To evaluate results of pre-operative radiochemotherapy followed by surgery for 15 patients with locally advanced un-resectable rectal cancer.
Methods:
15 patients with advanced non-resectable rectal cancer were treated with pre-operative irriadiation of 40-46 Gy plus concomitant chemotherapy (5-FU+LV and 5'-DFuR) (RCS group). For comparison, 27 similar patients, treated by preoperative radiotherapy (40-50 Gy) plus surgery were served as control (RS group).
Results:
No radiochemotherapy or radiotherapy was interrupted and then was delayed because of toxicities in both groups. The radical resectability rate was 73.3 % in the RCS group and 37.0 % (P=0.024) in RS group. Sphincter preservation rates were 26.6 % and 3.7 % respectively (P=0.028). Sphincter preservation rates of lower rectal cancer were 27.3 % and 0.0 % respectively (P=0.014). Response rates of RCS and RS groups were 46.7 % and 18.5 % (P=0.053). The tumor downstage rates were 8 (53.3 %) and 9 (33.3 %) in these groups (P=0.206). The 3-year overall survival rates were 66.7 % and 55.6 % (P=0.485), and the disease free survival rates were 40.1 % and 33.2 % (P=0.663). The 3-year local recurrent rates were 26.7 % and 48.1 % (P=0.174). No obvious late effects were found in either groups.
Conclusion:
High resectability is possible following pre-operative radiochemotherapy and can have more sphincters preserved. It is important to improve the quality of the patients' life even without increasing the survival or local control rates. Preoperative radiotherapy with concomitant full course chemotherapy (5-Fu+LV and 5'-DFuR) is effective and safe.