Response to neoadjuvant chemoradiation in locally advanced rectal cancer: Dokuz Eylül University experience
Aras Emre Canda, Cem Terzi, Sülen Sarıoğlu, İlknur Bilkay Görken, Hilmi Alanyalı, Funda Obuz, Uğur Yılmaz, İlhan Öztüp, Selman Sökmen, Mehmet Füzün
Dokuz Eylül Üniversitesi Tıp Fakültesi, İnciraltı, İZMİR
Abstract
Purpose: The aim of this study was to evaluate the response to neoadjuvant long course chemoradiotherapy (CRT) for patients with locally advanced rectal cancer with or without lymph node metastasis.
Materials and Methods: Between 1993 – 2007, 126 patients with locally advanced rectal cancer with or without lymph node involvement were treated at Dokuz Eylul University Medical Faculty Hospital. Prospectively collected data of patients were analyzed. All patients received concurrent CRT. Curative intend surgical resection was performed 4 to 8 weeks after the completion of CRT. Response to neoadjuvant CRT was assessed by comparing the preoperative clinical staging and postoperative pathological evaluation. Histopathological complete response (pCR) was defined as no tumor cells within the specimen. Downstaging of T and/or N stage of the tumor was defined as partial response (PR).
Results: Mean age was 57.9 years and 40,5% of patients were female, 59,5% of patients were male. Preoperative staging revealed T3 tumor in 54 (42,8%) of patients and T4 tumor in 58 (46%) of patients. In 32 (25,4%) patients there were no lymph node metastases (cN0) whereas in 94 (74,6%) patients lymph node involvement was detected (cN+). Tumor was located at lower rectum in 61,1% of patients, at mid-rectum in 25,4% of patients, and at upper rectum in 13,5% of patients. Sphincter saving resection was performed in 62,7% of patients. Histopathological complete response was observed in 13 (10,3%) patients. T stage downstaging was observed in 63 (%63) patients, N stage downstaging was observed in 57 (45,2%) patients, and PR was observed in 76 (60,3%) patients. No significant difference was observed between the response to neoadjuvant CRT and tumor localization and sphincter saving resection (P>0.05).
Conclusion: Response to neoadjuvant CRT was obtained in majority of the patients. Downstaging was not associated with the rate of sphincter preserving surgery. Surgical resection is still the primary treatment of resectable rectal cancer.
Keywords: Locally advanced rectal cancer, neoadjuvant chemoradiotherapy, downstaging