Abstract
Objective: To investigate the efficacy and safety of chemoradiotherapy and radiotherapy followed by surgery in patients with locally advanced unresectable rectal cancer.Material and method: We reviewed records for 65 patients with locally advanced unresectable rectal cancer treated by preoperative chemoradiotherapy or radiotherapy followed by surgery between 2013 and 2016. Of these, 23 patients were treated with preoperative chemoradiotherapy (40 - 45 Gy) plus concomitant chemotherapy (5Fluorouracil + Calcium Folinate). For comparison, 42 similar patients, treated by preoperative radiotherapy (45 - 50Gy) plus surgery served as control. The primary end-point of the study was overall survival and local control rate.Results: No treatment plan was delayed because of toxicities in both groups. The radical resectability rate was 69.9 % in the chemoradiotherapy group and 33.3 % in the radiotherapy plus surgery group (P = 0. 024). The anal sphincter preservation rates were 26. 6 % and 3. 7 %, respectively (P= 0. 028). The anal sphincter preservation rates of the lower rectal cancer were 27. 3 % and 0. 0 %, respectively (P = 0. 014). Response rates of chemoradiotherapy and radiotherapy plus surgery groups were 82.6 % and 61.9 % (P = 0. 053). The tumor downstage rates were 16 (69.6%) and 24 (57.1%) in these groups (P = 0. 206). The 3-years overall survival rates were 66. 7 % and 55. 6 % (P = 0. 485), and the tumor-free survival rates were 40. 3 % and 33. 1 % (P = 0. 663) . The 3-years local recurrent rates were 26. 9 % and 48. 1 % (P = 0. 174) . No obvious late effects were found in either group. Conclusion: The results of this study suggested at least that acute side effects of preoperative chemoradiotherapy can be tolerated and a higher surgical resection rate can be achieved. However, the chemoradiotherapy did not improve the survival rate while it increased local recurrence due to the high rate of anal sphincter preservation. It is safe and effective to use 5-Fluorouracil + Calcium Folinate and 5 – DFUR as a radiosensitizer during the whole course of radiotherapy.
Highlights
The curative effect of adjuvant radiotherapy (RT) for rectal cancer is a concern
The results of this study suggested at least that acute side effects of preoperative chemoradiotherapy can be tolerated, and a higher surgical resection rate can be achieved
A total of 23 patients with pathologically confirmed rectal cancer were set as the preoperative CRT group, including
Summary
The curative effect of adjuvant radiotherapy (RT) for rectal cancer is a concern. Before 2000, RT for rectal cancer inChina is mostly limited to postoperative treatment, and there are few reports on preoperative RT. The curative effect of adjuvant radiotherapy (RT) for rectal cancer is a concern. Before 2000, RT for rectal cancer in. There is no large sample study on its influence on the local recurrence rate, and preoperative RT in rectal cancer is not widely accepted in the entire surgical field because of the lack of support from the results of large clinical randomized controlled studies. For Integr J Med Sci.2022;9:1-5 patients with T3-4N0-2 M0 rectal cancer, preoperative RT or concomitant chemoradiotherapy (CRT) may be used to achieve the possible purpose of total mesorectal resection. Most clinical studies of preoperative CRT are based on platinum regimens to obtain the radiosensitizing effect. [15] This article retrospectively analyzes the efficacy and toxicity of preoperative CRT in patients with locally advanced unresectable rectal cancer Most clinical studies of preoperative CRT are based on platinum regimens to obtain the radiosensitizing effect. [15] This article retrospectively analyzes the efficacy and toxicity of preoperative CRT in patients with locally advanced unresectable rectal cancer
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