Preoperative hyperfractionated radiotherapy (HFRT) and concomitant chemotherapy (CT) in locally advanced primary rectal cancer (LA-PRC) in elderly patients

Abstract

3661 Background: The potential advantages of preoperative chemoradiation includes increased resectability, sphincter preservation (SP) and local control. We evaluated the feasibility, pathologic complete remissions (pCR) rate and SP of preoperative HFRT+CT in LA-PRC elderly pts (age ≥ 65 yrs). Patients and Methods: From 8/96 to 9/04 57 pts with LA-PRC were enrolled: M/F 40/17; median age 71 (range 65–81); median distance from the anal verge: 5 cm (range 1–14); T3/T4: 42/15.Thirty-seven out of 57 pts (65%) had invasive tumor involving distal half of rectum requiring abdominal-perineal resection. HFRT+CT consisted of 1.25 Gy twice a day with 6 hours interval (total dose 45 Gy) concomitant to continuous infusion of 5-Fluorouracil (250 mg/sqm/day). Surgery (S) was performed with total mesorectal excision technique after 6–8 wks of induction treatment. Results: All patients completed HFRT+CT and 55 underwent S (1 pt has just completed induction and 1 refused S). Fifty-three pts had curative resections and pTNM stage was as follows: pCR: 13 pts (23.6%), T1–2N0: 11, T3N0: 14, T2–3N1:12,T4N1:3. Dowstaging was observed in 35/55 pts (63%). Twenty-five out of 37 pts (67.5%) with lesions allocated in lower rectum had SP. Combined treatment was well tolerated: G3 diarrhoea and proctitis were recorded in respectively 12% and 8% of pts. Overall surgical morbidity was acceptable with no anastomotic leaks although one post-operative death was recorded. Nineteen pts were evaluable postoperatively by anorectal-manometry assessment: 12/19 (63%) showed well functioning sphincter. Adjuvant chemotherapy was performed in 16 pts with De Gramont or Mayo Clinic regimen for 4–6 months. With a median follow up of 25 months, 16 pts (28%) have died: 12 were related to rectal cancer progression and 4 were not related. Local recurrence occurred in 5 pts (8.7%) and 8 pts (14.5%) had visceral failures. Conclusion: These results demonstrate that HFRT+CT is feasible even in elderly pts obtaining similar results in term of pCR and SP as in younger pts. Longer follow up is required to confirm the benefit of combined treatment on local control rate and overall survival No significant financial relationships to disclose.