Outcomes Of Neoadjuvant Chemoradiotherapy In Patients With Locally Advanced Rectal Cancer: A Single Institution Experience

Year 2015, Volume: 1 Issue: 1, 1 - 5, 01.03.2015

Hasan Morcalı Metin Figen Ayşe Okumuş Nazmiye Deniz Arslan Hazım Orhan Kızılkaya

Abstract

Amaç: Neoadjuvan kemoradyoterapi lokal ileri rektum kanserli hastalarda standart tedavi töntemidir. Biz neoadjuvan kemoradyoterapi uygulanan lokal ileri rektum kanserli hastaların tedavi sonuçlarını retrospektif olarak incelemeyi amaçladık.
Gereç ve Yöntem: Ocak 2009-Temmuz 2012 tarihleri arasında neoadjuvan kemoradyoterapi (KRT)/radyoterapi (RT) yapılan lokal ileri evre rektum kanseri 35 hastanın kayıtlı verileri geriye dönük olarak analiz edildi. Hastalar yaş,cinsiyet, histopatoloji, tümör yerleşim yeri, klinik ve patolojik tümör,lenf nodu,metastaz (TNM) durumu ile cerrahi sonrası histopatolojik
tümör regresyon gradları (TRG) karılaştırmalı olarak değerlendirildi. Ayrıca yerel-bölgesel yineleme, uzak metastaz, genel
sağkalım oranlarına bakıldı.
Bulgular: Hastaların ortalama yaşı 56 (24-76) olup ortanca takip süreleri 21 ay (6-40 ay) ve hastaların 17’si (%48) kadın;
18’i (%52) erkekti. Takip süresince lokal nüks sayısının 3 (%8,57) olduğu saptanmıştır. Tümör regresyon gradları ile tedavi
öncesi T ve N evreleri arasında anlamlı ilişki vardı (P=0.10 ve 0.047, sırası ile). RT dozu ile TRG ve diğer parametreler arasında anlamlı ilişki bulunmadı. Eş zamanlı verilen KT rejimleri arasında tedavi sonuçları açısından anlamlı fark yoktu. Lokal
nüks görülen hastalar incelendiğinde ise nüks durumu, tümör diferansiyasyonu (P=0.009) ve histolojisi arasında anlamlı
ilişki vardı (P=0.017). On hastada (%28,57) hiçbir yan etki görülmezken , 25 hastada (%71,48) ise 1. veya 2. dereceden
akut dönem radyoterapi yan etkileri gözlendi. Yan etki görülen 25 hasta içinde en sık 18 vaka (%72,00) ile diare ve 17 vaka
(%68,00) ile cilt toksisitesi gözlendi.
Sonuç: Neoadjuvan radyokemoterapi lokal ileri rektum kanseri hastalarda lokal kontrole anlamlı katkı sağlayan, hastaların
tedavi sonrası hem T hemde N evrelerinde belirgin düşüşe sebep olan, ayrıca lokal yineleme oranlarını düşüren önemli
bir tedavi yöntemidir

Keywords

Rectal kanser, neoadjuvant keemoradioterapi, tümör regresyon grade

Outcomes of neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer: a single institution experience.

Abstract

Objectives: Neoadjuvant chemoradiotherapy (CRT) is the standard treatment for locally advanced rectal cancer. We aim
to examine clinical outcomes in locally advanced rectal cancer patients treated with neoadjuvant CRT retrospectively.
Material and Method: The medical records of 35 patients who were diagnosed with locally advanced stage rectal cancer
were analyzed retrospectively between the period of January 2009 and July 2012. Analyzed the data of patients were
age, sex, histopathological fi ndings, location of tumors, clinical and pathologic tumor, node, metastasis (TNM) with
postoperative histopathologic tumor regressions grades (TRG). Also, locoregional recurrence (LRR), distant metastases,
and overall survival (OS) of the patients were determined..
Results: The mean age of patients were 56 (24-76), the median follow-up time was 21 months (6-40 months) and 17
patients (48%) were women, remaining 18 (52%) were male. During the follow-up period local recurrence was diagnosed
in 3 (8,5%) patients. There was a signifi cant correlation between the tumor regression grade (TRG) with baseline T and
N stage of the patients (P=0.10 and 0.047, respectively). There was no signifi cant correlation between the radiotherapy
dosage and TRG as well as the other parameters. There were no signifi cant differences between the regimens of
concomitant chemotherapy for the clinical outcomes. When examined the patients with local recurrence there was a
signifi cant correlation between recurrence status, tumor differentiation (P=0.009) and tumor histology (P=0.017). No side
effects were seen in 10 patients (28.5%). Grade 1 or grade 2 acute side effects of radiation therapy were observed in 25
patients (72%). Diarrhea was observed in 18 (72.00%) patients and dermatologic toxicities were in 17 (68.00%) in these
patients.
Conclusion: Neoadjuvant chemoradiotherapy is an important treatment method in patients with locally advanced rectal
cancers. It laso contributes signifi cantly to local control and downstages for both T and N status. Local recurrence rates
were also lower in these patients. 

Keywords

Rectal cancer, neoadjuvant chemoradiotherapy, tumor regression grade

References

• 1. Local recurrence rate in a randomised multicentre trial of preoperative radiotherapy compared with operation alone in resectable rectal carcinoma. Swedish Rectal Cancer Trial. Eur J Surg 1996; 162: 397-402.
• 2. Thomas PR, Lindblad AS. Adjuvant postoperative radiotherapy and chemotherapy in rectal carcinoma: a review of the Gastrointestinal Tumor Study Group experience. Radiother Oncol 1988; 13: 245-52.
• 3. NIH Consensus Conference on Adjuvant Therapy for Patients with Colon and Rectal Cancer. JAMA 264:1444-1450, 1990
• 4. Sauer R, Becker H, Hohenberger W, Rodel C, Wittekind C, Fietkau R, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004; 351: 1731-40.
• 5. Ryan R, Gibbons D, Hyland JM, Treanor D, White A, Mulcahy HE, et al. Pathological response following long-course neoadjuvant chemoradiotherapy for locally advanced rectal cancer. Histopathology 2005; 47: 141-6.
• 6. Washington MK, Berlin J, Branton P, Burgart LJ, Carter DK, Fitzgibbons PL, Halling K, et al. Protocol for the Examination of Specimens From Patients With Primary Carcinoma of the Colon and Rectum. Arch Pathol Lab Med 2009; 133: 1539-51.
• 7. Heald RJ, Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1986; 1: 1479-82.
• 8. Van Gijn W, Marijnen CA, Nagtegaal ID, Kranenbarg EM, Putter H, Wiggers T, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol 2011; 12: 575-82.
• 9. Gérard JP, Conroy T, Bonnetain F, Bouché O, Chapet O, Closon-Dejardin MT, et al. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers: results of FFCD 9203. J Clin Oncol 2006; 24: 4620-5.
• 10. Bosset JF, Collette L, Calais G, Mineur L, Maingon P, Radosevic-Jelic, et al. Chemotherapy with preoperative radiotherapy in rectal cancer: EORTC Radiotherapy Group Trial 22921. N Engl J Med 2006; 355: 1114-23.
• 11. Biondo S, Navarro M, Marti-Rague J, Arriola E, Pares D, Del Rio C, et al. Response to neoadjuvant therapy for rectal cancer: influence on long-term results. Colorectal Dis 2005; 7: 472-9.
• 12. Martin ST, Heneghan HM, Winter DC. Systematic review and meta-analysis of outcomes following pathological complete response to neoadjuvant chemoradiotherapy for rectal cancer. Br J Surg 2012; 99: 918-28.
• 13. Huebner M, Wolff BG, Smyrk TC, Aakre J, Larson DW. Partial pathologic response and nodal status as most significant prognostic factors for advanced rectal cancer treated with preoperative chemoradiotherapy. World J Surg 2012; 36: 675-83.
• 14. Janjan NA, Crane C, Feig BW, Cleary K, Dubrow R, Curley S, et al. Improved overall survival among responders to preoperative chemoradiation for locally advanced rectal Am J Clin Oncol 2001; 24: 107-12.
• 15. Hohenberger W, Lahmer G, Fietkau R, Croner RS, Merkel S, Göhl J, et al. Neoadjuvant radiochemotherapy for rectal cancer. Chirurg 2009; 80: 294-302.
• 16. O'Connell MJ, Martenson JA, Wieand HS, Krook JE, Macdonald JS, Haller DG, et al. Improving adjuvant therapy for rectal cancer by combining protracted-infusion fluorouracil with radiation therapy after curative surgery. N Engl J Med 1994; 331: 502-7.
• 17. Miller RC, Sargent DJ, Martenson JA, Macdonald JS, Haller D, Mayer RJ, et al. Acute diarrhea during adjuvant therapy for rectal cancer: a detailed analysis from a randomized intergroup trial. Int J Radiat Oncol Biol Phys 2002; 54: 409-13.
• 18. Hofheinz RD, Wenz F, Post S, Matzdorff A, Laechelt S, Hartmann JT, et al. Chemoradiotherapy with capecitabine versus fluorouracil for locally advanced rectal cancer: a randomised, multicentre, non-inferiority, phase 3 trial. Lancet Oncol 2012; 13: 579-88.
• 19. Guillem JG, Díaz-González JA, Minsky BD, Valentini V, Jeong SY, Rodriguez-Bigas MA, et al. cT3N0 rectal cancer: potential overtreatment with preoperative chemoradiotherapy is warranted J Clin Oncol. 2008 Jan; 20: 368-73.
• 20. Koh DM, Chau I, Tait D, Wotherspoon A, Cunningham D, Brown G. Evaluating mesorectal lymph nodes in rectal cancer before and after neoadjuvant chemoradiation using thin-section T2-weighted magnetic resonance imaging. Int J Radiat Oncol Biol Phys. 2008; 71: 456-861.