Preoperative Radiochemotherapy (RT-CHT) and Total Mesorectal Excision (TME) for Mid and Low Rectal Cancer
Abstracts
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PURPOSE To analyze the outcome of a 12-yr consecutive series of pts with mid-low rectal cancer who underwent TME after neoadjuvant RT-CHT at a single institution. PATIENTS AND METHODS Among 522 pts operated on for rectal cancer between 1980 and 2001, 387 had mid-low rectal tumor. Since 1990, 111 (74 M, 37 F; mean age 58 yrs, range 26-79 yrs) have undergone TME after neoadjuvant RT-CHT (study group). Indications for neoadjuvant therapy were: stage II-III adenocarcinoma assessed by transrectal ultrasound and/or pelvic CT scan, ECOG performance score 0-2. Preoperative RT (45-50.4 Gys in 25-28 fractions) was administered in combination with 5-FU-based chemotherapy (bolus or continuous infusion). The following parameters were considered: acute toxicity, surgical procedure, radical surgery rate, pathologic stage (pTNM), postoperative mortality, local and distant recurrences, and overall survival. RESULTS. All pts concluded neoadjuvant treatment; 22 (20%) had grade 3+ acute toxicity. Surgical procedures were: abdominoperineal or Hartmann resection (n= 19), low anterior resection with stapled or hand-sewn anastomosis (n=88), and transanal local excision (n=4). Ninety-eight pts (82%) underwent radical surgery with one postoperative death. The median follow-up was 33 (range 0-121) months. The estimated 5-yrs OS and DFS rate were 70 and 75%, respectively. None of the pts had local, but 16 had distant recurrence. At the time of writing, 88 (80%) pts are alive and disease-free, 5 (4,5%) are alive with disease and 17 (16,3%) have died. CONCLUSIONS. Our findings suggest that in mid-low clinical stage II-III rectal cancer, neoadjuvant RT-CHT is feasible and the local control rate is high. The distant recurrences are still an unresolved question with this treatment. |
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