Effect of neoadjuvant chemoradiation on local control and disease-free survival in locally advanced rectal neoplasms

Year 2015, , 338 - 350, 01.11.2015

Remzi Kurt Ertuğrul Karğı Çağrı Tiryaki Zülfü Bayhan Hakan Uzunoğlu Oğuz Özbay

https://doi.org/10.5505/abantmedj.2015.00377

Abstract

OBJECTIVE: Although surgery comprises the basis for the treatment of locally advanced rectal cancer, the feasibility of curative resection and sphincter-sparing surgery depending on the reduction in tumour size has been reported to increase with neoadjuvant chemoradiation CRT in patients with locally advanced rectal cancer. The aim of this study was to investigate recurrence, survival with disease/disease-free survival and factors affecting them in patients who underwent surgery after receiving neoadjuvant CRT.METHODS: The files of 79 patients aged older than 18 years who were diagnosed with locally advanced rectal cancer and underwent surgery after receiving neoadjuvant CRT between January 2007 and May 2012 were retrospectively analysed in terms of demographics and clinical, radiological and pathological data.RESULTS: : A total of 79 patients, among whom 27 34.2% were females and 52 65.8% were males, were included in the study, and the mean age was 60.82±5 years. The complete regression rate after neoadjuvant CRT was 15.18%. The average follow-up period of the patients was 26 months range: 3–59 months . During the follow up, tumour recurrence was detected in 28 35.44% patients, among whom 12 had local recurrence and 17 had systemic recurrence; the survival rate of the patients was 83.54%. The disease-free survival rate was 72.15%. In most of the patients, stage regression and the reduction of tumour size were achieved.CONCLUSION: In summary, hyperfractionated radiotherapy sterilises the margins of the mesorectum and prevents the development of tumour cell remnants, thus reducing the likelihood of local recurrence and preventing tumour cells from metastasising to remote organs. The ideal surgical technique after neoadjuvant CRT is total mesorectal excision. The important question is the optimum time for surgery after CRT. Thus, further studies are required to understand the long-term follow-up results of recurrence and survival/disease-free survival in patients with locally advanced rectal cancer who received long-term neoadjuvant CRT.

Keywords

Locally advanced rectal neoplasms, neoadjuvant chemoradiation, disease-free survival

Lokal İleri Evre Rektum Tümörlerinde Neoadjuvan Kemoradyoterapinin Lokal Kontrol ve Hastalıksız Sağkalım Üzerine Etkisi

Abstract

AMAÇ: Lokal ileri rektum kanserlerinde tedavinin temelini cerrahi oluştuşturmakla beraber neoadjuvan kemoradyoterapi KRT ile lokal ileri rektum kanserlerinde tümör boyutunda küçülmeye bağlı küratif rezeksiyon ve sfinkter koruyucu cerrahi yapılabilirliğinin arttığı bildirilmiştir. Bu çalışmanın amacı, neoadjuvan KRT aldıktan sonra cerrahi tedavi yapılan hastalarda rekürrens, hastalıksız /hastalıklı sağkalım ve buna etki eden faktörlerin araştırılmasıdır.YÖNTEMLER: Ocak 2007- Mayıs 2012 tarihleri arasında lokal ileri rektum kanseri tanısı konularak neoadjuvan KRT sonrası ameliyat edilmiş olan 18 yaş üstü 79 hastanın dosya kayıtları; demografik, klinik, radyolojik ve patolojik veriler açısından retrospektif olarak incelendi.BULGULAR: Çalışmaya 27 %34.2 kadın, 52 %65,8 erkek olmak üzere toplam 79 hasta katılmış olup ortalama yaş 60,82±5’ dir. Neoadjuvan KRT sonrası tam regresyon oranı %15,18’dir. Hastaların ortalama takip süresi, 26 ay 3-59 ay aralığında olarak saptandı. Takip süresince 28 %35,44 hastada tümör rekürrensi saptanmış olup bunun 12 tanesi lokal, 17 tanesi sistemik rekürrensti. Takip süresince hastaların hayatta kalımı %.83,54 idi. Hastalıksız sağ kalım ise %.72,15 idi. Hastaların büyük çoğunluğunda evre gerilemesi ve tümör boyutlarında küçülme sağlandı.SONUÇ: Hiperfraksiyone RT mezorektumun sınırlarını sterilize eder ve tümör hücre kalıntılarının gelişmesini engeller. Bu durum lokal nüks ihtimalini azaltır ve muhtemelen tümör hücrelerinin uzak organlara giderek metastaz yapmasını da engellemiş olur. Neoadjuvan KRT sonrası yapılacak ideal ameliyat tekniği Total mezorektal eksizyon‘ dur. Cevaplanması gereken önemli soru ise KRT sonrası ideal ameliyat zamanlamasının ne olduğudurÇalışmamızda olgu sayısının az olması ve takip süresinin kısa olması nedeni ile uzun dönem neoadjuvan kemoradyoterapi uygulanan lokal ileri rektum kanserli hastalarda nüks, sağkalım/ hastalıksız sağkalımın uzun dönem takip sonuçlarının anlaşılması için başka çalışmalara ihtiyaç vardır.

Keywords

Lokal ileri rektum kanseri, neadjuan kemoradyoterapi, hastalıksiz sağkalım

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