Abstract
The study analyzed and compared the long term outcome in locally advanced rectal cancer treated with preoperative and postoperative concurrent chemoradiation (CCRT). A retrospective review of 105 patients with stage T3-T4 or regional lymph node positive adenocarcinoma of rectum treated with preoperative or postoperative CCRT at Ramathibodi Hospital during 2005 to 2010 was performed. The results of treatment were reported with 5-year overall survival (OS), 5- year locoregional recurrence free survival (LRFS), and toxicity according to preoperative versus postoperative concurrent chemoradiation (CCRT) groups. Among 105 patients, 34 (32%) were treated with preoperative CCRT and 71 (68%) with postoperative CCRT. At the median follow-up time of 50.5 months (range 2-114 months), five-year OS and LRFS of all patients were 87% and 91.6%, respectively. The study found no difference in 5-year OS (81.7% vs 89.2 %) or LRFS (83.4% vs 95.1%) between preoperative versus postoperative CCRT. Seven cases of loco-regional recurrence were diagnosed, 4 (11.8%) after preoperative CCRT and 3 (4.2%) after postoperative CCRT. The recurrent sites were anastomosis in all patients. There was no significant factor associated with outcome after univariate and multivariate testing. Grade 3 or 4 acute and late complications were low in both preoperative and postoperative CCRT groups. Locally advanced rectum cancer patients experience good results with surgery and adjuvant concurrent chemoradiation.
Highlights
Rectal cancer is the fifth most common cancer in Thailand
Several studies have consistently shown the benefit and better outcome of adjuvant concurrent chemoradiation (CCRT) in term of local control (LC), disease free survival (DFS) and overall survival (OS) than adjuvant radiation or chemotherapy alone (Thomas and Lindblad, 1988; Krook et al, 1991; Wolmark et al, 2000; Sauer et al, 2004; Kacaret al., 2009) With regard to adjuvant CCRT for locally advanced rectum cancer, there are two treatment options consisting of preoperative CCRT
Both preoperative and postoperative CCRT can be effective, preoperative treatment has emerged as the standard of care, because it is associated with tumor downstaging, improved resectibility and potential for expanded sphincter preservation options in the distal rectum and lower complication when compared to postoperative setting
Summary
Rectal cancer is the fifth most common cancer in Thailand. The annual incidence per 100,000 is 1935 in male and 1477 in female (Moore et al, 2010). Several studies have consistently shown the benefit and better outcome of adjuvant CCRT in term of local control (LC), disease free survival (DFS) and overall survival (OS) than adjuvant radiation or chemotherapy alone (Thomas and Lindblad, 1988; Krook et al, 1991; Wolmark et al, 2000; Sauer et al, 2004; Kacaret al., 2009) With regard to adjuvant CCRT for locally advanced rectum cancer, there are two treatment options consisting of preoperative CCRT and postoperative CCRT. The primary objective of this study is to analyze the difference of long term treatment outcomes
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