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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 2/2007

01-02-2007

Neoadjuvant Chemoradiation Versus Hyperfractionated Accelerated Radiotherapy in Locally Advanced Rectal Cancer

Authors: Wim Ceelen, MD, Tom Boterberg, MD, PhD, Piet Pattyn, MD, PhD, Marc van Eijkeren, MD, PhD, Jean-Marc Gillardin, MD, Pieter Demetter, MD, PhD, Peter Smeets, MD, Nancy Van Damme, PhD, Els Monsaert, MD, Marc Peeters, MD, PhD

Published in: Annals of Surgical Oncology | Issue 2/2007

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Abstract

Background

Neoadjuvant therapy is increasingly used in resectable locally advanced rectal cancer. The exact role of the addition of chemotherapy is not established. We compared neoadjuvant therapy using chemoradiation (CRT) or hyperfractionated accelerated radiotherapy (HART).

Methods

Clinical, pathological, and survival data were obtained from patients with resectable stage II or III rectal cancer within 7 cm from the anal verge. A group of 50 patients was treated with a preoperative dose of 41.6 Gy of radiotherapy (RT) in two daily fractions of 1.6 Gy over 13 days immediately followed by surgery (HART). A second group of 96 patients received 45 Gy of conventionally fractionated RT in 25 daily fractions of 1.8 Gy combined with 5-fluorouracil–based chemotherapy followed by surgery within 4 to 6 weeks (CRT). Both groups were compared in terms of morbidity, pathological downstaging, local recurrence, and survival.

Results

Both groups were comparable in terms of preoperative clinicopathological variables. The mean distance from the anal verge was 5.8 cm (HART) versus 4.9 cm (CRT). Sphincter preservation was possible in 74% (HART) versus 83.5% (CRT) of patients (P = .013). The clinical anastomotic leak rate was 2% (HART) versus 2.2% (CRT). Pathological complete response was observed in 4% (HART) versus 18% (CRT) of the resected specimens (P = .002). A pelvic recurrence developed in 6% (HART) versus 4.4% (CRT) of patients (P = .98). Overall 5-year survival was 58% (HART) versus 66% (CRT) (P = .19); disease-free 5-year survival was 51% (HART) versus 62% (CRT) (P = .037).

Conclusions

Compared with preoperative HART followed by immediate surgery, preoperative CRT followed by a 6-week waiting period enhances pathological response and increases sphincter preservation rate. This could be explained by the addition of chemotherapy or the longer interval between neoadjuvant therapy and surgery. No statistically significant difference was observed in local control or overall survival.
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Metadata
Title
Neoadjuvant Chemoradiation Versus Hyperfractionated Accelerated Radiotherapy in Locally Advanced Rectal Cancer
Authors
Wim Ceelen, MD
Tom Boterberg, MD, PhD
Piet Pattyn, MD, PhD
Marc van Eijkeren, MD, PhD
Jean-Marc Gillardin, MD
Pieter Demetter, MD, PhD
Peter Smeets, MD
Nancy Van Damme, PhD
Els Monsaert, MD
Marc Peeters, MD, PhD
Publication date
01-02-2007
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 2/2007
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-006-9102-0

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