Postoperative versus preoperative chemoradiotherapy in locally advanced rectal cancer patients.

Abstract

e14156 Background: Postoperative chemo-radiotherapy is the recommended standard therapy for patients with locally advanced rectal cancer. In recent years, encouraging results with preoperative radiotherapy have been reported. We compared preoperative with postoperative chemo-radiotherapy for locally advanced rectal cancer patients. Methods: 84 patients with locally advanced resectable rectal cancer (clinical stage T3 or T4 or node-positive disease), 44 from them received neo- adjuvant radio-chemotherapy (Group I) before surgical resection versus 40 locally advanced rectal cancer patients received adjuvant radio-chemotherapy then chemotherapy after surgical resection (Group II). Statistical analysis of treatment response, duration of disease free, time to progression, survival rates, treatment tolerability and toxicity. Results: There is no statistically significant difference between rectal cancer patients as regard either survival function or disease recurrence. The overall three-year survival rates OS were 95.5 % (Group I) and 95 % (Group II), respectively (P=0.638). The disease free three-year survival rates DFS were 75% (Group I) and 70 % (Group II), respectively (P=0.908). The three-year cumulative incidence of local relapse was 25 percent for patients assigned to preoperative chemo-radiotherapy and 30 percent in the postoperative-treatment group (P=0.63). After preoperative chemo-radiotherapy, there is a significant shift toward earlier TNM stages (P=0.002) tumour with down staging. Conclusions: Preoperative as compared with post operative chemo-radiotherapy has a significant down staging given that it is associated with a superior overall compliance rate, an improved rate of local control, reduced toxicity, and an increased rate (66 %) of sphincter preservation in patients with low-lying tumours but did not improve survival rate.