Preoperative infusional chemoradiation therapy for stage T3 rectal cancer.

Abstract

PURPOSE:

To evaluate preoperative infusional chemoradiation for patients with operable rectal cancer.

METHODS AND MATERIALS:

Preoperative chemoradiation therapy using infusional 5-fluorouracil (5-FU), (300 mg/m2/day) together with daily irradiation (45 Gy/25 fractions/5 weeks) was administered to 77 patients with clinically Stage T3 rectal cancer. Endoscopic ultrasound confirmed the digital rectal exam in 63 patients. Surgery was performed approximately 6 weeks after the completion of chemoradiation therapy and included 25 abdominoperineal resections and 52 anal-sphincter-preserving procedures.

RESULTS:

Posttreatment tumor stages were T1-2, N0 in 35%, T3 N0 in 25%, and T1-3, N1 in 11%; 29% had no evidence of tumor. Local tumor control after chemoradiation was seen in 96% (74 out of 77); 2 patients had recurrent disease at the anastomosis site and were treated successfully with abdominoperineal resection. Overall, pelvic control was obtained in 99% (76 out of 77). The survival after chemoradiation was higher in patients without node involvement than in those having node involvement (p = n.s.). More patients with pathologic complete responses or only microscopic foci survived than did patients who had gross residual tumor (p = 0.07). The actuarial survival rate was 83% at 3 years; the median follow-up was 27 months, with a range of 3 to 68 months. Acute, perioperative, and late complications were not more numerous or more severe with chemoradiation therapy than with traditional radiation therapy (XRT) alone.

CONCLUSIONS:

Excellent treatment response allowed two-thirds of the patients to have an anal-sphincter-sparing procedure. Gross residual disease in the resected specimen indicates a poor prognosis, and therapies specifically targeting these patients may improve survival further.

• Authors: T A Rich, J M Skibber, J A Ajani, D J Buchholz, K R Cleary, R A Dubrow, B Levin, P M Lynch, S H Meterissian, L D Roubein
• Journal: International journal of radiation oncology, biology, physics (Int J Radiat Oncol Biol Phys) Vol. 32 Issue 4 Pg. 1025-9 (Jul 15 1995) ISSN: 0360-3016 [Print] United States
• PMID: 7607922 (Publication Type: Journal Article, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Fluorouracil

Topics

• Adenocarcinoma (drug therapy, mortality, pathology, radiotherapy, surgery)
• Adult
• Aged
• Aged, 80 and over
• Combined Modality Therapy
• Drug Administration Schedule
• Female
• Fluorouracil (administration & dosage, adverse effects)
• Humans
• Male
• Middle Aged
• Neoplasm Staging
• Preoperative Care
• Rectal Neoplasms (drug therapy, mortality, pathology, radiotherapy, surgery)
• Survival Rate