Neoadjuvant concurrent chemoradiotherapy in treating locally advanced rectal cancer

Colorectal cancer is a common cancer and a major cause of morbidity and mortality worldwide. Middle to lower rectal cancer, a challenge for surgeons, is problematic. Neoadjuvant concurrent chemoradiotherapy (CCRT), introduced in the last decade, leads the local control of advanced rectal cancer to a high percentage of R0 resection (margin negative under microscopic examination) and a low recurrence rate.

From January 2005 to June 2007, 46 patients with locally advanced rectal cancer who received neoadjuvant CCRT were included. Factors including disease-free survival time, overall survival time, local recurrence, metastasis, and postoperative complications were evaluated retrospectively. Response was defined according to Mandard's classification, in which TRG1 is no residual tumor and TRG2-3 is 50-100% tumor shrinkage.

In this series, 3 patients who did not receive post-CCRT curative resection were excluded. The remaining 43 patients (22 males, 21 females) had received curative surgery and were included. Thirty-four patients had tumor shrinkage, and the response rate was 79% (Mandard's classification: TRG1-TRG3). The median follow-up time was longer than 1.5 years. Patients who responded to CCRT had lower local recurrence rates (5.9% vs. 55.6%; p = 0.002) and a greater curative resection rate (97.1% vs. 66.7%; p = 0.024). The complication rates of both groups were similar.

Neoadjuvant CCRT gives locally advanced rectal cancer patients a more favorable result, with acceptable toxicity.