NEOADJUVANT CHEMORADIOTHERAPY FOR PATIENTS WITH LOCALLY ADVANCED RECTAL CANCER. A RETROSPECTIVE STUDY ON PATIENTS TREATED AT THE CLINICAL COUNTY HOSPITAL OF SIBIU, BETWEEN 2011-2015
Abstract:
48 patients with local advanced or low-lying rectal cancer were treated with radiotherapy and
concurrent chemotherapy in our institution, from January 2011 to December 2015. 77% were cT3 and the rest
of them, 23 %, were cT4. The localisation of the tumour related to the anal verge was below 5 cm in 33 % of
the cases, while 67 % of the patients had middle and upper rectal tumours. Histopathologically, 87% were
moderately differentiated adenocarcinoma. Methods: all patients underwent pelvic radiotherapy with 45
Gy/1,8 Gy/fraction x 5 days/week, 25 fractions. Chemotherapy was given concomitantly and consisted of oral
Capecitabine 1600 mg/mp bid Monday-Friday, during radiotherapy. Seven patients could not finish the
concurrent treatment due to sever toxicities or non-compliance. 41 patients subsequent surgery 6 to 8 weeks
after concurrent chemoradiotherapy. Results: the most common acute toxicity was grade 1 to 2 diarrhea and
tenesmus during radiation. Only 5 of the 48 patients experienced symptomatic grade 3 acute toxicity. The
sphincter was preserved in only 4 out of the 16 patients in whom the tumour was located within 5 cm above the
anal verge, because the patients could not afford radical standard surgery (total mesorectal excision - TME)
at an Oncological Surgery Department. The 2-year overall survival rate was 81% and the disease-free
survival was 73 %. Our findings indicate that preoperative concurrent chemoradiotherapy allows low-lying
rectal tumours to be resected while preserving sphincter function at Oncological Surgery Department and also
results in good local control and acceptable toxicity. Conclusion: concurrent chemoradiotherapy is the
standard strategy for locally advanced rectal cancer. Neoadjuvant chemoradiotherapy reduces the pelvic
recurrence and improves the quality of the surgery. The management of rectal cancer must be a multi-modal
approach performed by an experienced multi-disciplinary expert team.
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