Preoperative Chemoradiotherapy (CRT) Followed by Laparoscopic Surgery for Rectal Cancer: Predictors of the Tumor Response and the Long-Term Oncologic Outcomes

Journal Article · Sat Oct 01 00:00:00 EDT 2011 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2010.05.019· OSTI ID:21587737

Lee, Jong Hoon ^[1]; Kim, Jun-Gi ^[2]; Cho, Hyun Min ^[3]; Shim, Byoung Yong ^[4]

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1. Department of Radiation Oncology, St. Vincent's Hospital, Catholic University of Korea, College of Medicine, Suwon (Korea, Republic of)
2. Laparoscopic Colorectal Surgery Center, Seoul St. Mary's Hospital, Catholic University of Korea, College of Medicine, Seoul (Korea, Republic of)
3. Laparoscopic Colorectal Surgery Center, St. Vincent's Hospital, Catholic University of Korea, College of Medicine, Suwon (Korea, Republic of)
4. Department of Medical Oncology, St. Vincent's Hospital, Catholic University of Korea, College of Medicine, Suwon (Korea, Republic of)

Purpose: We have evaluated the predictors of a tumor response to chemoradiotherapy (CRT) and the long-term oncologic outcomes of preoperative CRT and laparoscopic surgery for patients who suffer from rectal cancer. Methods and Materials: The study involved 274 patients with locally advanced rectal cancer and who had been treated with preoperative CRT and curative laparoscopic total mesorectal excision between January 2003 and January 2009. We assessed the long-term oncologic outcomes, in terms of recurrence and survival, of the treated patients. Results: Forty-two (15.3%) of the 274 patients had complete pathologic responses (pCR). The pre-CRT carcinoembryonic antigen level was the only significant predictor of a pCR on the multivariate analysis (p = 0.01). The overall survival at 5 years was 73.1%, with a mean survival period of 59.7 months (95% CI, 57.1-62.3). The disease-free survival at 5 years was 67.3% with a mean survival period of 54.7 months (95% CI, 51.7-57.8). The pCR group had a higher rate of overall survival at 5 years than did the non-pCR group, and the difference was significant (86.0% vs. 71.2%; hazard ratio = 0.87; 95% CI, 0.78-0.96; p = 0.03). The cumulative incidences of local and distant recurrences at 5 years were 5.8% and 28.3%, respectively. A total of 84.5% (234 of 274) of the patients had their anal sphincters preserved. Grade 3 or 4 acute and long-term toxic effects occurred in 22.2% and 8.4% of the patients, respectively. Conclusion: Preoperative CRT and laparoscopic surgery seems safe and feasible with favorable long-term outcomes and a high rate of sphincter preservation for the patients with low-lying tumors of the rectum.

• OSTI ID: 21587737
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Vol. 81, Issue 2; Other Information: DOI: 10.1016/j.ijrobp.2010.05.019; PII: S0360-3016(10)00698-X; Copyright (c) 2011 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
CARCINOEMBRYONIC ANTIGEN
COMBINED THERAPY
HAZARDS
MULTIVARIATE ANALYSIS
NEOPLASMS
POLYMERASE CHAIN REACTION
RECTUM
SURGERY
ANTIGENS
BODY
DIGESTIVE SYSTEM
DISEASES
GASTROINTESTINAL TRACT
GENE AMPLIFICATION
INTESTINES
LARGE INTESTINE
MATHEMATICS
MEDICINE
ORGANS
STATISTICS
THERAPY