Neoadjuvant intra-arterial polychemotherapy of locally advanced rectal cancer

In order to evaluate the usefulness of pre-operative intra-arterial selective polychemotherapy (PIASP), we carried out a retrospective study of 107 patients (65 males, 42 females) with locally advanced rectal cancer (LARC) (pT3-4 N0-1 M0), who were treated between 1988 and 1991. Fifty-two patients (MG) underwent PIASP (Adriablastin 60-90 mg, fluorouracil 3-4 g) with subsequent radical surgery. Fifty-five patients (R0) received surgery alone. Angiographic findings after PIASP showed approximately 50-70% reduction in the vascular network in the tumour and surrounding tissues. A post-operative morphological study confirmed the considerable tumour dystrophy, necrobiosis and necrosis. Comparative statistical analysis in two patient groups showed that overall 5-year survival was significantly better in MG (64.76 +/- 1.85%) than in R0 (38.23 +/- 1.74%; chi 2 = 9.1; P < 0.05). A similar situation was observed in all research subgroups: T3 N0 M0 (MG, 85.71 +/- 3.29% and R0, 65.63 +/- 2.85%; chi 2 = 2.61; P < 0.05); T3 N1 M0 (MG, 47.06 +/- 4.68% and R0, 0.0, chi 2 = 14.37; P < 0.05); T4 N0-1 M0 (MG, 8.57 +/- 4.29% and R0, 0.0, chi 2 = 2.09; P < 0.05). Significantly better 5-year survival rates were seen in MG than in R0 with the medial cellular differentiation in carcinoma (77.42 +/- 2.98% and 36.23 +/- 2.41%, chi 2 = 9.81; P < 0.05, respectively), the most frequent histological tumour structures. There is a trend for improved 5-year survival in low differentiation carcinoma (MG, 47.62 + 5.29% and R0, 35.29 +/- 4.37%, chi 2 = 0.28, P > 0.05). The MG group showed eight local relapses of disease (15.38%), while the R0 group showed 21 (38.1%), the MG group demonstrated 12 distant metastasis (23.07%) while R0 demonstrated 19 (34.54%), the median relapse-free survival was 101.6 weeks in MG and 74.45 weeks in R0. The use of the combined PIASP with subsequent surgery treatment of patients with LARC allows a better prognosis than does surgery alone.