The Effectiveness of Off-Protocol Upfront Chemotherapy and Preoperative Short-Course Radiation Therapy Followed by Delayed Surgery for Patients With Locally Advanced Rectal Cancer and Synchronous Metastases

Abstract

Purpose/Objective(s): To assess the necessity of elective inguinal irradiation in locally advanced rectal cancer involving anal canal. Materials/Methods: Between January 2001 and September 2011, 1246 patients with Stage II, III rectal cancer received preoperative or postoperative chemoradiation. Radiation therapy was administered without elective inguinal irradiation. The anal canal ( 3 cm from the anal verge) was involved in 189 patients (Group A) and 1057 patients (Group B) presented no involvement. Five-year inguinal recurrence rate and pattern of failure of patients with inguinal recurrence were analyzed. Results: The median follow-up period was 63 months. Eleven patients presented inguinal recurrence: 7 in Group A and 4 in Group B. The 5-year inguinal recurrence rate was 4.3% in Group A and 0.3% in Group B, respectively (p < 0.001). Among 11 patients, 8 patients presented simultaneous loco-regional or distant failure, and 3 patients had solitary inguinal recurrence that underwent successful salvage. Conclusions: Although inguinal recurrence rate in rectal cancer patients involving anal canal is higher than the other, most of patients presented pattern of multiple site failure at the time of inguinal metastasis. Patients with solitary inguinal recurrence could be successfully salvaged. Thus, the elective inguinal irradiation is not recommended for locally advanced rectal cancer patients involving anal canal. Author Disclosure: H. Lim: None. D. Kim: None. T. Kim: None. S. Kim: None. J. Baek: None. H. Chang: None. J. Park: None. J. Oh: None.