Cancer Res Treat.  2012 Jun;44(2):104-112.

Preoperative Concurrent Chemoradiotherapy for Locally Advanced Rectal Cancer: Treatment Outcomes and Analysis of Prognostic Factors

• Kong M
• Hong SE
• Choi WS
• Kim SY
• Choi J

Abstract

PURPOSE
This study was designed to investigate the long-term oncologic outcomes for locally advanced rectal cancer patients after treatment with preoperative concurrent chemoradiotherapy followed by total mesorectal excision, and to identify prognostic factors that affect survival and pathologic response.
MATERIALS AND METHODS
From June 1996 to June 2009, 135 patients with locally advanced rectal cancer were treated with preoperative concurrent chemoradiotherapy followed by total mesorectal excision at Kyung Hee University Hospital. Patient data was retrospectively collected and analyzed in order to determine the treatment outcomes and identify prognostic factors for survival.
RESULTS
The median follow-up time was 50 months (range, 4.5 to 157.8 months). After preoperative chemoradiotherapy, sphincter preservation surgery was accomplished in 67.4% of whole patients. A complete pathologic response was achieved in 16% of patients. The estimated 5- and 8-year overall survival, loco-regional recurrence-free survival, and distant metastasis-free survival rate for all patients was 82.7% and 75.7%, 76.8% and 71.9%, 67.9% and 63.3%, respectively. The estimated 5- and 8-year overall survival, loco-regional recurrence-free survival, and distant metastasis-free survival rate for pathologic complete responders was 100% and 100%, 100% and 88.9%, 95.5% and 95.5%, respectively. In the multivariate analysis, pathologic complete response was significantly associated with overall survival. The predictive factor for pathologic complete response was pretreatment clinical stage.
CONCLUSION
Preoperative chemoradiotherapy for locally advanced rectal cancer resulted in a high rate of overall survival, sphincter preservation, down-staging, and pathologic complete response. The patients achieving pathologic complete response had very favorable outcomes. Pathologic complete response was a significant prognostic factor for overall survival and the significant predictive factor for a pathologic complete response was pretreatment clinical stage.

Keyword

Rectal neoplasms; Preoperative care; Chemoradiotherapy; Pathologic complete response

MeSH Terms

Chemoradiotherapy
Follow-Up Studies
Humans
Multivariate Analysis
Preoperative Care
Rectal Neoplasms
Retrospective Studies
Survival Rate

Figure

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  Fig. 1 Overall survival for whole patients and pathologic complete response (pCR) patients. The estimated 5- and 8-year overall survival rates for whole patients were 82.7% and 75.7%, and for pCR patients were 100% and 100%, respectively.

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  Fig. 2 Loco-regional recurrence-free survival for whole patients and pathologic complete response (pCR) patients. The estimated 5- and 8-year loco-regional recurrence-free survival rates for whole patients were 76.8% and 71.9%, and for pCR patients were 100% and 88.9%, respectively.

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  Fig. 3 Distant metastasis-free survival for whole patients and pathologic complete response (pCR) patients. The estimated 5- and 8-year distant metastasis-free survival rates for whole patients were 67.9% and 63.3%, and for pCR patients were 95.5% and 95.5%, respectively.

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