J Korean Soc Ther Radiol Oncol.  2003 Jun;21(2):125-134.

Preoperative Concurrent Radio-chemotherapy for Rectal Cancer: Report of Early Results

• Shin SS
• Ahn YC
• Chun HK
• Lee WY
• Kang WK
• Park YS
• Park JO
• Song SY
• Lim DH
• Park W
• Lee JE
• Kang MK
• Park YJ
• Nam HR
• Kim KJ
• Huh SJ

Abstract

PURPOSE: To report the early results of preopeartive concurrent radio-chemotherapy (CRCT) for treating rectal cancer.
MATERIALS AND METHODS
From June 1999 to April 2002, 40 rectal cancer patients who either had lesions with a questionable resectability or were candidates for sphincter-sacrificing surgery received preoperative CRCT. Thirty-seven patients completed the planned CRCT course. 45 Gy by 1.8 Gy daily fraction over 5 weeks was delivered to the whole pelvis in the prone position. The chemotherapy regimens were oral UFT plus oral leucovorin (LV) in 12 patients, intravenous bolus 5-FU plus LV in 10 patients, and intravenous 5-FU alone in 15 patients (bolus infusion in 10, continuous infusion in 5). Surgery was planned in 4~6 weeks of the completion of the preoperative CRCT course, and surgery was attempted in 35 patients.
RESULTS
The compliance to the current preoperative CRCT protocol was excellent, where 92.5% (37/40) completed the planned treatment. Among 35 patients, in whom surgery was attempted after excluding two patients with new metastatic lesions in the liver and the lung, sphincter-preservation was achieved in 22 patients (62.9%), while resection was abandoned during laparotomy in two patients (5.7%). Gross complete resection was performed in 30 patients, gross incomplete resection was performed in one patient, and no detailed information on the extent of surgery was available in two patients. Based on the surgical and pathological findings, the down-staging rate was 45.5% (15/33), and the complete resection rate with the negative resection margin 78.8% (26/33). During the CRCT course, grade 3~4 neutropenia developed in four patients (10.8%). Local recurrence after surgical resection developed in 12.1% (4/33), and distant metastases after the preoperative CRCT start developed in 21.6% (8/37). The overall 3-years survival rate was 87%.
CONCLUSION
Preoperative CRCT in locally advanced rectal cancer is well tolerated and can lead to high resection rate, down-staging rate, sphincter preservation rate, however, longer term follow-up will be necessary to confirm these results.

Keyword

Rectal cancer; Preoperative treatment; Concurrent radio-chemotherapy

MeSH Terms

Compliance
Drug Therapy
Fluorouracil
Follow-Up Studies
Humans
Laparotomy
Leucovorin
Liver
Lung
Neoplasm Metastasis
Neutropenia
Pelvis
Prone Position
Rectal Neoplasms*
Recurrence
Survival Rate
Fluorouracil
Leucovorin