open access

Vol 15, No 3 (2010)
Untitled
Published online: 2010-05-01
Submitted: 2009-12-31
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Impact of neoadjuvant chemoradiation on pathologic response and survival of patients with locally advanced rectal cancer

Sofia Conde, Margarida Borrego, Tânia Teixeira, Rubina Teixeira, Maria Corbal, Anabela Sá, Paula Soares
DOI: 10.1016/j.rpor.2010.04.002
·
Rep Pract Oncol Radiother 2010;15(3):51-59.

open access

Vol 15, No 3 (2010)
Untitled
Published online: 2010-05-01
Submitted: 2009-12-31

Abstract

Background

The impact of neoadjuvant chemotherapy (CT) and radiotherapy (RT) on overall survival (OS) has been controversial. Some studies have pointed to an improvement in OS and disease-free survival (DFS) in patients with pathologic complete response (pCR).

Aim

To evaluate the therapeutic response and impact on survival of preoperative RT, alone or combined with CT, in patients with locally advanced rectal cancer (LARC).

Materials and methods

A set of 132 patients with LARC were treated preoperatively. GROUP 1: RT alone, 19 patients. GROUP 2: RT and concomitant oral CT (Capecitabine or UFT[[ce:hsp sp="0.25"/]]+[[ce:hsp sp="0.25"/]]leucovorin), 68 patients. GROUP 3: RT and concomitant CT with 5-FU in continuous infusion, 45 patients. 58.2% of patients were submitted to adjuvant CT.

Results

GROUP 1: no pCR, tumoral downstaging was 26.7%. GROUP 2: pCR in 16.9%; tumoral downstaging was 47.7%. GROUP 3: pCR in 11.9%; tumor downstaging was 52.4%. The loco-regional control (LRC) was 95%. The 5-year OS (p[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]0.038) and DFS (p[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]0.05) were significantly superior in patients treated with CT[[ce:hsp sp="0.25"/]]+[[ce:hsp sp="0.25"/]]RT. Patients with pCR had a significant increase on DFS (p[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]0.019). Patients cT3–4 that had a tumoral downstaging to ypT0–2, showed an increase on DFS, OS and LRC.

Conclusions

CT combined with RT has increased tumoral response and survival rate. Nodal downstaging and pCR were higher in the GROUP 2. The 5-year OS and DFS were significantly superior in CT[[ce:hsp sp="0.25"/]]+[[ce:hsp sp="0.25"/]]RT arms. Patients with pathologic response showed a better DFS. Adjuvant CT had no impact on LRC, DFS nor on OS.

Abstract

Background

The impact of neoadjuvant chemotherapy (CT) and radiotherapy (RT) on overall survival (OS) has been controversial. Some studies have pointed to an improvement in OS and disease-free survival (DFS) in patients with pathologic complete response (pCR).

Aim

To evaluate the therapeutic response and impact on survival of preoperative RT, alone or combined with CT, in patients with locally advanced rectal cancer (LARC).

Materials and methods

A set of 132 patients with LARC were treated preoperatively. GROUP 1: RT alone, 19 patients. GROUP 2: RT and concomitant oral CT (Capecitabine or UFT[[ce:hsp sp="0.25"/]]+[[ce:hsp sp="0.25"/]]leucovorin), 68 patients. GROUP 3: RT and concomitant CT with 5-FU in continuous infusion, 45 patients. 58.2% of patients were submitted to adjuvant CT.

Results

GROUP 1: no pCR, tumoral downstaging was 26.7%. GROUP 2: pCR in 16.9%; tumoral downstaging was 47.7%. GROUP 3: pCR in 11.9%; tumor downstaging was 52.4%. The loco-regional control (LRC) was 95%. The 5-year OS (p[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]0.038) and DFS (p[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]0.05) were significantly superior in patients treated with CT[[ce:hsp sp="0.25"/]]+[[ce:hsp sp="0.25"/]]RT. Patients with pCR had a significant increase on DFS (p[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]0.019). Patients cT3–4 that had a tumoral downstaging to ypT0–2, showed an increase on DFS, OS and LRC.

Conclusions

CT combined with RT has increased tumoral response and survival rate. Nodal downstaging and pCR were higher in the GROUP 2. The 5-year OS and DFS were significantly superior in CT[[ce:hsp sp="0.25"/]]+[[ce:hsp sp="0.25"/]]RT arms. Patients with pathologic response showed a better DFS. Adjuvant CT had no impact on LRC, DFS nor on OS.

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Keywords

Rectal cancer; Neoadjuvant chemoradiotherapy; Pathologic complete response; Adjuvant chemotherapy

About this article
Title

Impact of neoadjuvant chemoradiation on pathologic response and survival of patients with locally advanced rectal cancer

Journal

Reports of Practical Oncology and Radiotherapy

Issue

Vol 15, No 3 (2010)

Pages

51-59

Published online

2010-05-01

DOI

10.1016/j.rpor.2010.04.002

Bibliographic record

Rep Pract Oncol Radiother 2010;15(3):51-59.

Keywords

Rectal cancer
Neoadjuvant chemoradiotherapy
Pathologic complete response
Adjuvant chemotherapy

Authors

Sofia Conde
Margarida Borrego
Tânia Teixeira
Rubina Teixeira
Maria Corbal
Anabela Sá
Paula Soares

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