Comparison between preoperative and postoperative concurrent chemoradiotherapy for rectal cancer: an institutional analysis

• Published in: Radiation oncology journal 2013, 31(3), , pp.155-161
• Main Authors: Lee, Jeong Won, Lee, Jong Hoon, Kim, Jun-Gi, Oh, Seong Taek, Chung, Hyuk Jun, Lee, Myung Ah, Chun, Hoo Geun, Jeong, Song Mi, Yoon, Sei Chul, Jang, Hong Seok
• Format: Article
• Language: English
• Subjects: Original; 방사선과학
• ISSN: 2234-1900; 2234-3156; 2234-3164
• DOI: 10.3857/roj.2013.31.3.155

To evaluate the treatment outcomes of preoperative versus postoperative concurrent chemoradiotherapy (CRT) on locally advanced rectal cancer. 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. 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). 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.