Comparison between preoperative and postoperative concurrent chemoradiotherapy for rectal cancer: an institutional analysis.
10.3857/roj.2013.31.3.155
- Author:
Jeong Won LEE
1
;
Jong Hoon LEE
;
Jun Gi KIM
;
Seong Taek OH
;
Hyuk Jun CHUNG
;
Myung Ah LEE
;
Hoo Geun CHUN
;
Song Mi JEONG
;
Sei Chul YOON
;
Hong Seok JANG
Author Information
1. Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea. hsjang11@catholic.ac.kr
- Publication Type:Original Article
- Keywords:
Rectal cancer;
Concurrent chemoradiotherapy
- MeSH:
Chemoradiotherapy;
Disease-Free Survival;
Fluorouracil;
Follow-Up Studies;
Humans;
Rectal Neoplasms;
Retrospective Studies
- From:Radiation Oncology Journal
2013;31(3):155-161
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: To evaluate the treatment outcomes of preoperative versus postoperative concurrent chemoradiotherapy (CRT) on locally advanced rectal cancer. MATERIALS AND METHODS: Medical data of 114 patients with locally advanced rectal cancer treated with CRT preoperatively (54 patients) or postoperatively (60 patients) from June 2003 to April 2011 was analyzed retrospectively. 5-Fluorouracil (5-FU) or a precursor of 5-FU-based concurrent CRT (median, 50.4 Gy) and total mesorectal excision were conducted for all patients. The median follow-up duration was 43 months (range, 16 to 118 months). The primary end point was disease-free survival (DFS). The secondary end points were overall survival (OS), locoregional control, toxicity, and sphincter preservation rate. RESULTS: The 5-year DFS rate was 72.1% and 48.6% for the preoperative and postoperative CRT group, respectively (p = 0.05, the univariate analysis; p = 0.10, the multivariate analysis). The 5-year OS rate was not significantly different between the groups (76.2% vs. 69.0%, p = 0.23). The 5-year locoregional control rate was 85.2% and 84.7% for the preoperative and postoperative CRT groups (p = 0.98). The sphincter preservation rate of low-lying tumor showed significant difference between both groups (58.1% vs. 25.0%, p = 0.02). Pathologic tumor and nodal down-classification occurred after the preoperative CRT (53.7% and 77.8%, both p < 0.001). Acute and chronic toxicities were not significantly different between both groups (p = 0.10 and p = 0.62, respectively). CONCLUSION: The results confirm that preoperative CRT can be advantageous for improving down-classification rate and the sphincter preservation rate of low-lying tumor in rectal cancer.
