Preoperative radiochemotherapy treatment in advanced rectal carcinoma. Results of 8-year follow up

Abstract

3634 Background: Preoperative radiochemotherapy (RCT) may play an important role in decreasing local recurrence and possibly improving survival for advanced rectal carcinoma. Methods: 30 patients (pts) (median age 61.5) with advanced low rectal cancer, from 1995 to1998 were treated by RCT prior to surgery. Radiotherapy was administered to the pelvis using 10MV linear accelerator to the pelvis to a total dose of 45Gy given over five weeks. 5-FU (500mg/m2/day i.v.) was given concomitantly on days 1–3 and 29–31. Surgery was performed 2- 4 weeks after RCT and included abdominal perineal resection in 15 pts, anterior resection in 11 pts, transanal resection of tumor - 1 pt, explorative laparotomy - 1 pt and only 2 pts refused surgery. Results: There were no serious toxicities associated with RCT. Mild to moderate transient radiation dermatitis was noted in three pts, and grade II diarrhea in four pts. Postoperative pathologic staging was as follows: no tumor found (CR)- 4 pts, Dukes B1–5 pts, Dukes B2–17 pts, B3 (vaginal involvement)-1 pt, C2–2 pt, and D1–1 pt. The response rate was: CR –13%, PR –77%, NC –10%. The 5 and 8 year overall survival was 70% and 58% respectively. Necrosis and/or fibrosis was noted as a prominent histopathologic feature. Conclusions: Preoperative RCT in this series of 30 pts with advanced rectal cancer was well tolerated and associated with a high response rate. No significant financial relationships to disclose.