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01-12-2004 | Original Contributions

Preoperative Chemoradiotherapy and Total Mesorectal Excision Surgery for Locally Advanced Rectal Cancer: Correlation With Rectal Cancer Regression Grade

Authors: J. M. D. Wheeler, M.D., F.R.C.S., E. Dodds, B.M., B.S., B. F. Warren, F.R.C.Path., C. Cunningham, M.D., F.R.C.S., B. D. George, M.S., F.R.C.S., A. C. Jones, M.R.C.P., F.R.C.R., N. J. McC Mortensen, M.D., F.R.C.S.

Published in: Diseases of the Colon & Rectum | Issue 12/2004

PURPOSE

Preoperative long-course chemoradiotherapy is recommended for rectal carcinoma when there is concern that surgery alone may not be curative. Downstaging of the tumor can be measured as rectal cancer regression grade (1-3) and may be of importance when estimating the prognosis. The aim of this study was to look at the long-term results of tumor regression in patients receiving long-course chemotherapy before surgical resection of rectal cancer.

METHODS

We reviewed those patients who received preoperative chemoradiotherapy followed by surgical resection for carcinoma of the mid rectum or distal rectum found to be stage T3/4 between January 1995 and November 1999. Patients received 45 to 50 Gy irradiation in 2-Gy fractions and an infusion of 5-fluorouracil. Surgical specimens were assessed for rectal cancer regression grade. Patients were followed up routinely with clinical examination, computed tomography, and colonoscopy.

RESULTS

Sixty-five patients with a mean age 65 (range, 32–83) years underwent chemoradiotherapy before surgical resection. Thirty patients (46 percent) were classified as rectal cancer regression Grade 1, with 9 patients (14 percent) having complete sterilization of the tumor. Fifty-three patients (82 percent) underwent a curative resection. Overall survival, with a median follow-up of 39 (range, 24–83) months, was 67 percent and was associated with tumor downstaging. The local recurrence rate was 5.8 percent in those patients who underwent a curative resection and was significantly lower with rectal cancer regression Grade 1 tumors (P = 0.03). Eight of nine patients (89 percent) whose tumor had been sterilized were alive and well with no recurrence of tumor at a median follow-up of 41 (range, 24–70) months.

CONCLUSIONS

Preoperative chemoradiotherapy resulted in significant regression of tumor. Overall survival was high and was associated with downstaging of tumor. The local recurrence rate was significantly lower with rectal cancer regression Grade 1 tumors and was not seen in patients with sterilized tumors.

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Title: Preoperative Chemoradiotherapy and Total Mesorectal Excision Surgery for Locally Advanced Rectal Cancer: Correlation With Rectal Cancer Regression Grade
Authors: J. M. D. Wheeler, M.D., F.R.C.S.
E. Dodds, B.M., B.S.
B. F. Warren, F.R.C.Path.
C. Cunningham, M.D., F.R.C.S.
B. D. George, M.S., F.R.C.S.
A. C. Jones, M.R.C.P., F.R.C.R.
N. J. McC Mortensen, M.D., F.R.C.S.
Publication date: 01-12-2004
Publisher: Springer-Verlag
Published in: Diseases of the Colon & Rectum / Issue 12/2004
Print ISSN: 0012-3706
Electronic ISSN: 1530-0358
DOI: https://doi.org/10.1007/s10350-004-0713-x

Keynote webinar | Spotlight on medication adherence

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Preoperative Chemoradiotherapy and Total Mesorectal Excision Surgery for Locally Advanced Rectal Cancer: Correlation With Rectal Cancer Regression Grade

PURPOSE

METHODS

RESULTS

CONCLUSIONS

Keynote webinar | Spotlight on medication adherence

Springer Medicine

PURPOSE

METHODS

RESULTS

CONCLUSIONS

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