Postoperative adjuvant chemoradiotherapy in patients with rectal cancer. Prognostic factors for locoregional control and survival

Abstract

Aim

The aim of this study is to assess the results of postoperative radiochemotherapy in pts with rectal cancer, factors influencing prognosis with regard to causes of failure and treatment tolerance.

Materials/Methods

Between 1993 and 2002, 178 pts with Dukes stage B or C rectal cancer received postoperative chemoradiotherapy. Median age was 62; 110 patients were males, 68 were females. Median follow-up time was 45 months. Sixty-nine patients had stage B and 109 had stage C disease. Main endpoints of the analysis were locoregional recurrence-free survival (LRRFS), disease-free survival (DFS) and overall survival (OS). Kaplan-Meier method was used to calculate survival rates. Univariate and multivariate analyses of prognostic factors were performed using log rank test and Cox's proportional hazard method.

Results

The 5-year LRRFS was 73%, DFS was 61% and OS was 65%. Lymph node involvement and method of resection (AR favoured) were the only independent prognostic factors for LRRFS. Lymph node involvement, in particular when four or more were involved, was the independent prognostic factor for DFS. For OS, the independent prognostic factors were infiltration of the pararectal fatty tissue, lymph node involvement in particular when four or more were involved, and total number of chemotherapy cycles (at least six favoured). Radiation therapy was well tolerated in 45% of patients. The most common early reactions were diarrhoea, nausea/vomiting and leucopoenia.

Neither SER (start of any treatment to the end of radiotherapy) nor total treatment time appeared to be of prognostic significance in this group of patients.

Conclusions

Involvement of lymph nodes and method of resection were the only independent prognostic factors for LRRFS. Prognostic factors for OS were infiltration of the pararectal fatty tissue, lymph node metastases, four or more involved lymph nodes, and total number of chemotherapy cycles.