High dose chemoradiotherapy increases chance of organ preservation with satisfactory functional outcome for rectal cancer.

Abstract

BACKGROUND:

High dose chemoradiotherapy offers a curative chance for patients with rectal cancer that are unfit or unwilling to undergo surgical resection, yet its long-term survival and functional outcomes have been rarely investigated.

METHODS:

Patients with non-metastatic rectal adenocarcinoma who received pelvic radiation for curative intent from April 2006 to July 2017 were retrospectively investigated. Survival rates were analyzed using the Kaplan-Meier method. Quality of life and functional outcomes were evaluated using the EORTC quality of life questionnaire.

RESULTS:

A total of 57 patients were included, with a median age of 59.0 (range, 29-84) years. The numbers of patients who were diagnosed as stage I, II and III were 5 (8.8%), 16 (28.1%) and 36 (63.2%), respectively. 53 (93.0%) patients had tumor located within 5 cm from the anal verge. All patients received fluorouracil-based concurrent chemoradiotherapy with a median radiation dose of 80 (range, 60-86) Gy. All kinds of grade 3-4 adverse events occurred in 18 (31.6%) patients. 42 (73.7%) patients achieved a clinical complete response after chemoradiotherapy. After a median follow-up of 43.5 (range 14.9-163.2) months, 12 (21.1%) patients had local progression and 11 (19.3%) developed distant metastasis. The 3-year local recurrence-free survival and distant metastasis-free survival were 77.3% (95% CI, 65.7-88.8%) and 79.2% (95% CI, 68.2-90.2%), while the 3-year progression-free survival, cancer-specific survival, overall survival were 61.9% (95% CI, 48.8-75.0%), 93.1% (95% CI, 85.8-100.0%) and 91.4% (95% CI, 83.6-99.2%), respectively. For patients who had tumor located within 3 cm from the anal verge, the sphincter preservation rate was 85.3% at last follow-up. Long-term adverse events mainly were anal blood loss. 21 patients completed the quality-of-life questionnaire and had a score of the global health status of 78.57 ± 17.59. Of them, 95.2% reported no urinary incontinence and 85.7% reported no fecal incontinence.

CONCLUSIONS:

High dose chemoradiation demonstrated promising survival outcomes with acceptable short-term and long-term side effects, and satisfying long-term functional outcomes and quality of life. It could be considered as a non-invasive alternative for rectal cancer patients who refuse surgery.

• Authors: Qiao-Xuan Wang, Shu Zhang, Wei-Wei Xiao, Cheng-Jing Zhou, Hui Chang, Zhi-Fan Zeng, Pei-Qiang Cai, Zhen-Hai Lu, Gong Chen, Pei-Rong Ding, Zhi-Zhong Pan, Xiao-Jun Wu, Yuan-Hong Gao
• Journal: Radiation oncology (London, England) (Radiat Oncol) Vol. 17 Issue 1 Pg. 98 (May 18 2022) ISSN: 1748-717X [Electronic] England
• PMID: 35585551 (Publication Type: Journal Article)
• Copyright: © 2022. The Author(s).

Topics

• Adult
• Aged
• Aged, 80 and over
• Chemoradiotherapy (adverse effects)
• Humans
• Middle Aged
• Neoadjuvant Therapy
• Neoplasm Recurrence, Local (pathology)
• Neoplasm Staging
• Organ Preservation
• Quality of Life
• Rectal Neoplasms (pathology)
• Retrospective Studies
• Treatment Outcome