Role of neo-adjuvant chemoradiation in locally advanced rectal cancers

To determine the radiologic downstaging and histological response after neo-adjuvant concurrent chemoradiation in locally advanced rectal cancers.

Case series.

Radiation Oncology department of Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, from December 2004 to November 2005.

Thirty patients with histopathologically confirmed locally advanced carcinoma rectum who had not received any treatment (chemotherapy, radiotherapy or surgery) prior to presentation were enrolled. Radiation therapy was delivered with a three-field technique to a dose of 50.4 Gy over 5 weeks at the rate of 1.8 Gy/day. Two cycles of chemotherapy were given synchronously, which comprised of 5-fluorouracil 350 mg/m2 and folinic acid 20 mg/m2 continuous intravenous infusion over first five days and last five days of radiotherapy. Surgery was planned 4-6 weeks later to chemoradiation after radiologic post therapy staging. Viable specimens were identified and toxicity was observed.

All patients completed treatment without modification. Radiologic downstaging was found in 56.7%, stable disease was seen in 30.0% and progressive disease was present in 13.3% of the patients. Radiologically complete resolution of tumour was not observed. Pathological complete resolution of tumour was achieved in 3.3% and near complete resolution was observed in 13.3% of the patients. In 86.6% cases, a total gross tumour resection with no macroscopic residual disease was possible. All the patients tolerated the treatment well.

Neo-adjuvant chemoradiation for locally advanced rectal cancers is associated with high resectability rate and is relatively safe with acceptable morbidity which favours its use in future.