The Pathological and Clinical Effects of Preoperative Chemoradiation in Rectal Cancer.
10.3857/jkstro.2011.29.1.11
- Author:
Jin Ho SONG
1
;
Hong Seok JANG
;
Yeon Sil KIM
;
Su Mi CHUNG
;
Seok Hyun SON
;
Jin Hyeong KANG
;
Eui Gon YOUK
;
Doo Seok LEE
;
Suk Hi LEE
;
Sei Chul YOON
Author Information
1. Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea School of Medicine, Seoul, Korea. scyoon@catholic.ac.kr
- Publication Type:Original Article
- Keywords:
Rectal cancer;
Preoperative concurrent chemoradiation;
Concomitant boost technique
- MeSH:
Disease-Free Survival;
Fluorouracil;
Follow-Up Studies;
Humans;
Rectal Neoplasms;
Survival Rate
- From:The Journal of the Korean Society for Therapeutic Radiology and Oncology
2011;29(1):11-19
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: To evaluate the pathological and clinical effects of preoperative chemoradiation (CCRT) in cases of locally advanced rectal cancer and to determine the predictive factors for tumor downstaging. MATERIALS AND METHODS: From March 2004 to August 2008, 33 patients with locally advanced rectal cancer were treated with preoperative CCRT. Twenty-eight patients (84.8%) were treated using a concomitant boost technique while five (15.2%) patients were treated using a cone down boost technique. All patients received 50.4 Gy of irradiation and concurrent chemotherapy with 5-fluorouracil. The median follow-up duration was 24.2 months (range, 9.8 to 64.7 months). RESULTS: Thirty-one (93.9%) patients underwent surgery. Twenty-four patients (72.7%) underwent anal sphincter-preserving surgery. The 3-year disease free survival (DFS) and overall survival rates were 63.4% and 78.8%, respectively. Post-operative factors were more important for DFS. Pathologic N stage, margin status, and pathologic differentiation were significant prognostic factors (p=0.001, 0.029, 0.030). Tumor size and lymphovascular invasion were also associated with marginal significance (p=0.081, 0.073). However, only pre-treatment T stage was a significant pre-operative factor (p=0.018). The complete pathological response rate was 9.1%. T-downstaging was observed in ten (30.3%) patients, whereas N-downstaging was found in 24 (72.7%) patients. Pre-treatment T stage and the interval between CCRT and operation were the predictive factors for downstaging in a univariate analysis (p=0.029, 0.027). Pre-treatment carcinoembryogenic antigen was also associated with marginal significance (p=0.068). CONCLUSION: The survival of rectal cancer patients can be better determined based on post-operative findings. Therefore, pre-operative CCRT for downstaging of the tumor seems to be important. Pre-treatment T stage and the interval between CCRT and operation can be used to predict downstaging.
