Abstract
BackgroundWe investigated the efficacy and prognosis of neoadjuvant chemoradiotherapy (NACRT) for Japanese locally advanced rectal carcinoma patients.MethodsFifty-seven patients diagnosed with cT3-4 or any cT/cN+ disease using enhanced computed tomography or magnetic resonance imaging from 2002 to 2014 were enrolled. The male/female ratio was 42/15, and the median age was 67 years. Ra/Rb/Rb-P/P was expressed by 6/35/14/2 patients. Histological tumor types were tub1/tub2/por/muc in 22/30/4/1 patients. For NACRT, radiotherapy doses were 40–50.4 Gy chemotherapy consisted of 5′-DFUR, capecitabine, or S1.ResultsAll 57 patients received curative surgical treatment. The anal preservation rate was 65.0 %. The ypStage of 0/I/II/IIIa/IIIb was 7/10/25/11/4 cases. The histological antitumor effect (HATE) was ≥grade (G) 2 and G3 in 31 (54.4 %) and 7 (12.3 %) cases, respectively. Postoperative complications occurred in 17 patients and exceeded GIII (Clavien–Dindo classification) in four patients. Recurrence was observed in 19 patients; the primary local recurrence rate was 5.3 %. The 3-year relapse-free survival (RFS) and overall survival (OS) rates were 64.8 and 95.5 %, respectively; the 5-year RFS and OS rates were 60.2 and 61.0 %, respectively. In multivariate analysis, ypN+ was a high-risk factor for distant organ recurrence. As predictive factors regarding the efficacy of NACRT, a neutrophil concentration <70 % and a neutrophil/lymphocyte ratio <3.0 in peripheral blood prior to treatment indicated that NACRT would be significantly more effective.ConclusionsNACRT was effective in reducing local recurrence but did not suppress distant organ recurrence in Japanese locally advanced rectal carcinoma patients. A further investigation of an extension of the NACRT regimen is required.
Highlights
We investigated the efficacy and prognosis of neoadjuvant chemoradiotherapy (NACRT) for Japanese locally advanced rectal carcinoma patients
We investigated the usefulness, efficacy, and prognosis of NACRT in Japanese Locally advanced rectal cancer (LARC) patients, concerning the histological antitumor effect (HATE) and long-term outcomes such as relapse-free survival (RFS), overall survival (OS), and recurrence rate
Fifty-seven LARC patients who had no distant metastasis and had undergone histopathologically complete resection (September 2002 to April 2014) with total mesorectal excision (TME) were enrolled in the study
Summary
We investigated the efficacy and prognosis of neoadjuvant chemoradiotherapy (NACRT) for Japanese locally advanced rectal carcinoma patients. Advanced rectal cancer (LARC) has often developed postoperative local recurrence. To manage postoperative pelvic local control and downstage LARC, multimodal therapy such as neoadjuvant chemoradiotherapy (NACRT) is frequently used in Western countries [2,3,4]. In Japan, the standard treatment for LARC is total mesorectal excision and lateral pelvic lymph node dissection; postoperative outcomes using surgery alone were better than those of Western countries, and NACRT has not been introduced aggressively. Several phase II studies regarding the Tokuhara et al World Journal of Surgical Oncology (2016) 14:136 safety and efficacy of NACRT in Japanese patients have been reported [7,8,9]
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