A Study on the Advanced Rectal Cancer treated with Neoadjuvant Chemoradiation

Hiroki Moriuchi, Yoshito Ikematsu, Taichiro Kosaka, Masato Ogiku, Hiroaki Kuroda, Takao Yamamoto, Yoshiro Nishiwaki, Hideo Kida, Shinji Waki and Mitsuharu Iijima*

Department of Surgery and Department of Radiology*, Hamamatsu Medical Center

Introduction: We studied the oncologic outcome and effects of neoadjuvant chemoradiation (CRT) in patients with advanced rectal cancer. Methods: We analyzed 28 patients with advanced rectal cancer treated by neoadjuvant CRT and 74 patients without from January 1991 to October 2004. Both groups consisted of clinicopathologically Stage II-III cases based on the Japanese colorectal carcinoma classification. CRT patients underwent radical rectal cancer resection at 2-week intervals from the completion of neoadjuvant CRT (radiation: total dose of 40 Gy and simultaneous 5-FU-based chemotherapy). Results: The estimated 5-year overall survival was 73.2% and the estimated 5-year local recurrence was 11.1% in the CRT group and 67.5% and 32.9% in the group without CRT. A significant difference was seen in estimated 5-year local recurrence between the two groups (p<0.05). In postoperative distant recurrence, no significant difference was seen between the CRT group (21.4%) and the group without CRT (15.9%). Distant recurrence was not defined in the CRT group during the wait for surgery. Response (CR+PR) was 78.6%, curative resection 92.9% (CurA+B), APR 39.3% (11 APR cases), and morbidity 42.9% in the CRT group. Pathological complete response (pCR) was 14.3% (4/28 cases). All four pCR cases remain alive without local on distant recurrence. Conclusions: The more we work to improve multimodality therapy for increasing the pCR of resected specimens using neoadjuvant CRT, the more therapy decreases local recurrence and improves the prognosis for advanced rectal cancer.

Key words
rectal cancer, neoadjuvant chemoradiation (CRT), pathological complete response (pCR), prognosis, recurrence

Reprint requests
Hiroki Moriuchi Department of Surgery, National Hospital Organization Saga National Hospital
20-1 Hinodemachi, Saga, 849-8577 JAPAN

Accepted
September 24, 2008

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