Postoperative Chemoradiotherapy in Locally Advanced Rectal Cancer

Chai, Gyu Young; Kang, Ki Mun; Choi, Sang Gyeong

Abstract

PURPOSE: To evaluate the role of postoperative chemoradiotherapy in locally advanced rectal cancer, we retrospectively analyzed the treatment results of patients treated by curative surgical resection and postoperative chemoradiotherapy.
MATERIALS AND METHODS
From April 1989 through December 1998, 119 patients were treated with curative surgery and postoperative chemoradiotherapy for rectal carcinoma in Gyeongsang National University Hospital. Patient age ranged from 32 to 73 years, with a median age of 56 years. Low anterior resection was performed in 59 patients, and abdominoperineal resection in 60. Forty-three patients were AJCC stage II and 76 were stage III. Radiation was delivered with 6 MV X rays using either AP-PA two fields, AP-PA both lateral four fields, or PA both lateral three fields. Total radiation dose ranged from 40 Gy to 56 Gy. In 73 patients, bolus infusions of 5-FU (400 mg/m2) were given during the first and fourth weeks of radiotherapy. After completion of radiotherapy, an additional four to six cycles of 5-FU were given. Oral 5-FU (Furtulone) was given for nine months in 46 patients.
RESULTS
Forty (33.7%) of the 119 patients showed treatment failure. Local failure occurred in 16 (13.5%) patients, 1 (2.3%) of 43 stage II patients and 15 (19.7%) of 76 stage III patients. Distant failure occurred in 31 (26.1%) patients, among whom 5 (11.6%) were stage II and 26 (34.2%) were stage III. Five-year actuarial survival was 56.2% overall, 71.1% in stage II patients and 49.1% in stage III patients (p=0.0008). Five-year disease free survival was 53.3% overall, 68.1% in stage II and 45.8% in stage III (p=0.0006). Multivariate analysis showed that T stage and N stage were significant prognostic factors for five year survival, and that T stage, N stage, and preoperative CEA value were significant prognostic factors for five year disease free survival. Bowel complication occurred in 22 patients, and was treated surgically in 15 (12.6%), and conservatively in 7 (5.9%).
CONCLUSION
Postoperative chemoradiotherapy was confirmed to be an effective modality for local control of rectal cancer, but the distant failure rate remained high. More effective modalities should be investigated to lower the distant failure rate.