Use of adjuvant, preoperative chemo-radiotherapy in patients with locally advanced rectal cancer

• Published in: ANZ journal of surgery 2002-09, Vol.72 (9), p.639-642
• Main Authors: Platell, Cameron, Cassidy, Barry, Heywood, Janelle, Claringbold, Phillip
• Format: Article
• Language: English
• Subjects: Adult; Aged; chemotherapy; Chemotherapy, Adjuvant; colorectal cancer; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local - therapy; Preoperative Care; Prospective Studies; radiotherapy; Radiotherapy, Adjuvant; rectal cancer; Rectal Neoplasms - drug therapy; Rectal Neoplasms - mortality; Rectal Neoplasms - radiotherapy; Rectal Neoplasms - surgery; surgery; survival; Survival Analysis
• ISSN: 1445-1433; 1445-2197
• DOI: 10.1046/j.1445-2197.2002.02513.x

Background:  The objective of this study was to perform a non‐randomised prospective examination of the efficacy of adjuvant, preoperative chemo‐radiotherapy in patients with locally advanced rectal cancer. Methods:  Between 1996 and 2001, patients presenting with biopsy‐proven, locally advanced, rectal cancers within 12 cm of the anal verge were referred for a long course of adjuvant chemo‐radiotherapy prior to their surgery. Locally advanced lesions were defined by either: (i) endoanal ultrasound showing at least full thickness penetration of the rectal wall (i.e. T3, T4); (ii) abdominal computed tomography scan showing infiltration of adjacent structures, or; (iii) clinical examination demonstrating a fixed lesion. All patients were followed through the hospital colorectal unit. A Kaplan−Meier survival analysis was used to determine survival and local recurrence rates. Results:  There were 60 patients with a mean age of 61.5 years (range 33−77 years) with a sex distribution of males to females of 1.7−1.0. Curative resections were performed in 81% of these patients. The remainder (n = 12) were found to have either metastatic disease at operation (n = 5), inoperable disease (n = 2), or had positive resection margins on histology (n = 7). The mean follow up was 2.1 years (maximum 5.1 years). The overall 2‐year survival rate was 86.1% (95% CI ±5.4%). In patients undergoing curative resections, the overall 2‐year survival rate was 91.4% (95% CI ±4.8%), and the 2‐year disease free survival rate was 85.1% (95% CI ±6.2%). The 2‐year local recurrence rate was 7.5%. Conclusions:  The use of adjuvant, preoperative, chemo‐radiotherapy in patients with locally advanced rectal cancer is associated with high short‐term survival and a low recurrence rate.