A favourable pathological stage after neoadjuvant radiochemotherapy in patients with initially irresectable rectal cancer correlates with a favourable prognosis

O Reerink, RCJ Verschueren, BG Szabo, GAP Hospers, NH Mulder*

*Corresponding author for this work

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55 Citations (Scopus)

Abstract

Initial treatments of locally advanced rectal cancers focus on local control, as local relapse of a rectal cancer is correlated with a high morbidity and mortality. We studied the effect of neoadjuvant radiochemotherapy on advanced rectal cancer patients in relation to downstaging, local relapse and survival. Post-treatment pathological staging, local relapse and survival were analysed in 66 patients from a single institution. 43 patients had irresectable cancer as determined by laparatomy (n = 42) or rectal examination (n = 1). These 43 patients received 45-56 Gy preoperatively with 5-fluorouracil (5-FU) and leucovorin (350/20 mg/m(2) x 5 day (d)) in weeks I and 5 during the radiation therapy. 23 patients had primary resectable tumours with a T1-2 stage. Of the initially irresectable tumours 79% became macroscopically resectable, in 74% a R0 resection was performed. In 6 of 34 (18%) surgical specimens, no tumour was found (pT0), 7 patients had small tumour remnants (pT1-2). In these pT0-2 tumours, no local relapses occurred (observation period of median 4.5 years, range 18-87 months). In the 21 patients with pT3-4 tumours 3 local relapses were seen. In the 23 patients with primary resectable T1-2 tumours the relapse rate was 4%. Downstaging of an initially irresectable rectal tumour to pT2 or less results in a local relapse rate and overall survival that correspond with the rates in primary resectable cancer with the same T classification. (C) 2002 Elsevier Science Ltd. All rights reserved.

Original languageEnglish
Article numberPII S0959-8049(02)00557-9
Pages (from-to)192-195
Number of pages4
JournalEuropean Journal of Cancer
Volume39
Issue number2
Publication statusPublished - Jan-2003

Keywords

  • rectal cancer
  • downstaging
  • neo-adjuvant
  • radiochemotherapy
  • METASTATIC COLORECTAL-CANCER
  • FIRST-LINE TREATMENT
  • MULTICENTER RANDOMIZED TRIAL
  • PREOPERATIVE CHEMOTHERAPY
  • P53 STATUS
  • FLUOROURACIL
  • LEUCOVORIN
  • RADIATION
  • RADIOTHERAPY
  • CHEMORADIOTHERAPY

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