Impact of neoadjuvant chemoradiation on pathologic response and survival of patients with locally advanced rectal cancer

✍ Scribed by Sofia Conde; Margarida Borrego; Tânia Teixeira; Rubina Teixeira; Maria Corbal; Anabela Sá; Paula Soares

• Publisher: Wielkopolskie Centrum Onkologii
• Year: 2010
• Tongue: Polish
• Weight: 699 KB
• Volume: 15
• Category: Article
• ISSN: 1507-1367
• DOI: 10.1016/j.rpor.2010.04.002

✦ Synopsis

Background:

The impact of neoadjuvant chemotherapy (ct) and radiotherapy (rt) on overall survival (os) has been controversial. some studies have pointed to an improvement in os and disease-free survival (dfs) in patients with pathologic complete response (pcr).

Aim:

To evaluate the therapeutic response and impact on survival of preoperative rt, alone or combined with ct, in patients with locally advanced rectal cancer (larc).

Materials and methods:

A set of 132 patients with larc were treated preoperatively. group 1: rt alone, 19 patients. group 2: rt and concomitant oral ct (capecitabine or uft + leucovorin), 68 patients. group 3: rt and concomitant ct with 5-fu in continuous infusion, 45 patients. 58.2% of patients were submitted to adjuvant ct.

Results:

Group 1: no pcr, tumoral downstaging was 26.7%. group 2: pcr in 16.9%; tumoral downstaging was 47.7%. group 3: pcr in 11.9%; tumor downstaging was 52.4%. the loco-regional control (lrc) was 95%. the 5-year os (p = 0.038) and dfs (p = 0.05) were significantly superior in patients treated with ct + rt. patients with pcr had a significant increase on dfs (p = 0.019). patients ct3-4 that had a tumoral downstaging to ypt0-2, showed an increase on dfs, os and lrc.

Conclusions:

Ct combined with rt has increased tumoral response and survival rate. nodal downstaging and pcr were higher in the group 2. the 5-year os and dfs were significantly superior in ct + rt arms. patients with pathologic response showed a better dfs. adjuvant ct had no impact on lrc, dfs nor on os.