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

Öz

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

Anahtar Kelimeler

• 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

Kaynakça

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