Abstract
Background and objectives: Advanced rectal cancers require local and systemic control. Chemo radiotherapy (CRT) is adequate to achieve adequate local control. Systemic control, however, is a dominant obstacle remained in debates. We compared oncology outcome in both arms in patients with advanced rectal cancers in order to identify high-risk group of distant metastasis. Methods: Data for 723 patients for advanced rectal cancer from 2005 to 2013 retrieved retrospectively. Patients were classified to CRT (n=364) or no CRT (n=359) arms. Results: CRT group showed greater local control and achieved pT stage 0, 1, or 2 in 43.7% vs. 28.4% in no CRT (p<0.001) and less CEA marker (11.17 ± 25.2 vs. 6.14 ± 11.3, p<0.001), respectively. Although CRT group had higher rates of advanced tumors, cT3 or T4 (341(93.7%) vs. 294(81.9%), p<0.001) and CRM threat (167 (45.9%) vs. 30(8.4%); p<0.001). Overall local recurrence rate observed in no CRT 3% compared to 2.1% in CRT arm, (p<0.005). Systemic recurrence rate was similar in both groups, (22.5% vs. 23%), respectively. Conclusion: CRT is efficient to downstage locally advanced rectal cancer, not systemic control though. Early recognition of high-risk group is recommended in order to consider CRT modification ahead of planned surgery.
Highlights
Colorectal cancer (CRC) is a leading cause of cancer-related mortality worldwide, with over 1.2 million new cases diagnosed each year [1]
Preoperative level of the carcinoembryonic antigen (CEA) marker was elevated in the Chemo radiotherapy (CRT) group (11.17 ± 25.2 vs. 6.14 ± 11.3, p
High-risk features were more commonly found in the CRT group; lower rectum tumor was present in 150 patients (41.2%) vs. 66 (18.4%) vs. in CRT and no CRT group, respectively (p
Summary
Colorectal cancer (CRC) is a leading cause of cancer-related mortality worldwide, with over 1.2 million new cases diagnosed each year [1]. Surgical approaches for rectal cancer have evolved markedly with the development of a promising standardized approach for total mesorectal excision (TME), which was first described by Professor Bill Heald [2]. Screening programs and increased colorectal cancer (CRC) literacy have contributed to improved detection of early cancer, with 5-year survival ranging from 50% to 90% with adequate surgery [3]. Several techniques and procedures have been developed to enhance surgical management and reduce comorbidity. Neo adjuvant chemo radiotherapy (CRT) has shown effectiveness in advanced rectal cancer in term of tumor down staging, sphincter preservation, and reduction of local recurrence, but has failed to achieve systemic control [4,5]. Advanced rectal cancers require local and systemic control. Chemo radiotherapy (CRT) is adequate to achieve adequate local control. We compared oncology outcome in both arms in patients with advanced rectal cancers in order to identify high-risk group of distant metastasis
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