Abstract
Our study evaluated long-term survival outcomes in rectal cancer patients treated with preoperative radiotherapy, and the impact on survival of concomitant and postoperative adjuvant chemotherapy (ctx), among other prognostic factors. The study included 196 patients [median age: 58 years (range: 20-86 years); 63.0% men] with locally advanced rectal carcinoma and, in some cases, resectable liver metastasis. Rates of distant metastasis and local recurrence and of 5-year distant metastasis-free survival (dmfs) and overall survival (os) were determined. The 5-year os rate was 57.0%, with a median duration of 81.5 months (95% confidence interval: 73.7 months to 89.4 months), and the 5-year dmfs rate was 54.1%, with a median duration of 68.4 months (95% confidence interval: 40.4 months to 96.4 months). Prognostic factors for higher os and dmfs rates were downstaging (p = 0.013 and p = 0.005 respectively), radiotherapy dose (50 Gy vs. 56 Gy or 45-46 Gy, both p = 0.002), and concomitant ctx use (p = 0.004 and p = 0.001) and type (5-fluorouracil-leucovorin-folinic acid vs. tegafur-folinic acid, p = 0.034 and p = 0.043). Adjuvant ctx after neoadjuvant long-term concomitant chemoradiotherapy (ccrt) and surgery was associated with better 5-year os rates for postoperative T0-T3 disease (p = 0.003) and disease at all lymph node stages (p = 0.001). Our findings revealed a favourable survival outcome with long-term fractionated irradiation and concomitant 5-fluorouracil-based ctx, achieving 5-year os and dmfs rates of 57.0% and 54.1% respectively. Preoperative administration of radiotherapy (50 Gy) and postoperative adjuvant ctx were associated with a significant survival benefit. Radiation doses above 50 Gy and the interval between ccrt and surgery had no significant effect on survival.
Highlights
Rectal cancer is the 3rd most common malignancy worldwide and a major cause of cancer-related death in the developed world[1,2]
The newer-generation chemotherapeutics such as capecitabine, S-1, oxaliplatin, and irinotecan have been suggested to further enhance the disease control rate and to improve survival in patients with advanced colorectal cancer[7,8,9]
Our findings reveal that concomitant ctx (85.0%) and postoperative adjuvant ctx (69.8%) were given in most of our rectal cancer patients
Summary
Rectal cancer is the 3rd most common malignancy worldwide and a major cause of cancer-related death in the developed world[1,2]. In view of high rates of local recurrence and poor survival in rectal cancer patients even after curative resection (40%–55% at 5 years), multimodal therapeutic options have gained importance to provide the optimum sequence and combination of radiotherapy (rt), chemotherapy (ctx), and surgery[4,5]. The newer-generation chemotherapeutics such as capecitabine, S-1, oxaliplatin, and irinotecan have been suggested to further enhance the disease control rate and to improve survival in patients with advanced colorectal cancer[7,8,9]. Our study evaluated long-term survival outcomes in rectal cancer patients treated with preoperative radiotherapy, and the impact on survival of concomitant and postoperative adjuvant chemotherapy (ctx), among other prognostic factors
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
