Delayed surgery of locally advanced low rectal cancer after preoperative concurrent chemo-radiotherapy, trial for sphincter- saving radical resection with good local control

Abstract

To evaluate multimodality treatment therapy in patients with locally advanced low rectal adenocarcinoma as a trial for sphincter-saving radical resection with good local control. Twenty two patients underwent preoperative concurrent chemoradiotherapy, (CCRT) and radical resection for locally advanced low rectal adenocarcinoma. Patients received preoperative bolus 5-fluorouracil (5-FU) and leucovorin concurrent with radiotherapy to a total dose of 50.4 Gy, followed by radical resection surgery 6 weeks after CCRT. Fifty-five percent of patients achieved tumor downstaging, 14% of patients showed pathological complete remission, sphincter-saving rate was 82%, and there were no deaths related to preoperative CCRT or surgery. Mild hematological and gastrointestinal toxicity was noted during the course of preoperative CCRT. Overall, 3-year survival rate was 78% and the rate of locoregional recurrence was 13.6%. This study showed that many patients with locally advanced rectal cancer can be operated on with sphincter-saving radical resection surgery under good local control after preoperative CCRT which induces tumor downstaging.