Adjuvant versus neoadjuvant chemoradiotherapy in distal rectal cancer: Comparison of two decades in a single center

• Published in: Turkish journal of surgery 2015, Vol.31 (4), p.218-223
• Main Authors: Zengel, Baha, Uslu, Adam, Adıbelli, Zehra, Yetiş, Halit, Cengiz, Fevzi, Aykas, Ahmet, Şimşek, Cenk, Akpınar, Göksever, Eliyatkın, Nuket, Duran, Ali
• Format: Article
• Language: English
• Subjects: Cancer therapies; Chemotherapy; NMR; Nuclear magnetic resonance; Original Investigation; Radiation therapy; Surgery
• ISSN: 1300-0705; 2564-6850; 1308-8521; 2564-7032
• DOI: 10.5152/UCD.2015.3015

Standard surgery alone was not able to decrease local recurrence (LR) rate below 20% in rectal cancer treatment. Thus, many centers administered neoadjuvant radiotherapy (preopRTx) with or without concomitant chemotherapy for the prevention of LR. In this study, the results of 164 consecutive patients with mid- and distal rectal cancer who received surgery and adjuvant chemoradiotherapy (Group A) or neoadjuvant chemoradiotherapy (Group NA) followed by surgery are presented. The staging system used in this study is that of the American Joint Committee on Cancer (AJCC), also known as the TNM system. Eligible patients were required to have radiologically assessed stage 1 (only T2N0M0) to stage 3C (T4bN1-2M0) tumor with pathologically confirmed R0 resection. The surgical method was total mesorectal excision (TME). Radiotherapy was applied with daily 180 cGy fractions for 28 consecutive days. Chemo-therapy comprised 5-fluorouracil (450 mg/m(2)/d) and leucovorin (20 mg/m(2)/d) bolus at days 1-5 and 29-33. Nine patients (13%) in Group NA achieved pathologic complete response (pCR). In Group NA and Group A, locoregional recurrence (LRR) rates were 6.7% and 30.8%, (p