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Radiation Oncology
Published in: Radiation Oncology 1/2006

Open Access 01-12-2006 | Research

Neoadjuvant radiochemotherapy in the treatment of fixed and semi-fixed rectal tumors. Analysis of results and prognostic factors

Authors: Robson Ferrigno, Paulo Eduardo Ribeiro dos Santos Novaes, Maria Letícia Gobo Silva, Ines Nobuko Nishimoto, Wilson Toshihiko Nakagawa, Benedito Mauro Rossi, Fábio de Oliveira Ferreira, Ademar Lopes

Published in: Radiation Oncology | Issue 1/2006

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Abstract

Purpose

To report the retrospective analysis of patients with locally advanced rectal cancer treated with neodjuvant radiochemotherapy.

Methods and Materials

From January 1994 to December 2003, 101 patients with fixed (25%) or semi-fixed (75%) rectal adenocarcinoma were treated by preoperative radiotherapy with a dose of 45Gy at the whole pelvis and 50.4Gy at primary tumor, concomitant to four weekly chemotherapies with 5-Fluorouracil (425 mg/m2) and Leucovorin (20 mg/m2). In 71 patients (70.3%) the primary tumor was located up to 6 cm from the anal verge and in 30 (29.7%) from 6.5 cm to 10 cm. Age, gender, tumor fixation, tumor distance from the anal verge, clinical response, surgical technique, and postoperative TNM stage were the prognostic factors analyzed for overall survival (OS), disease-free survival (DFS), and local control (LC) at five years.

Results

Median follow-up time was 38 months (range, 2–141). Complete response was observed in eight patients (7.9%), partial in 54 (53.4%) and absence in 39 (38.7%). OS, DFS and LC were 52.6%, 53.8%, and 75.9%, respectively. Distant metastasis occurred in 40 (39.6%) patients, local recurrence in 20 (19.8%) and both in 16 (15.8%). Patients with fixed tumors had lower OS (17% Vs 65.6%; p < 0.001), DFS (31.2% Vs 60.9%; p = 0.005), and LC (58% Vs 82%; p = 0.004). Patients with tumors more than 6 cm above the anal verge had better LC (93% Vs 69%; p = 0.04). The postoperative TNM stage was a significant factor for DFS (I:64.1%, II:69.6%, III:35.2%, IV:11.1%; p < 0.001) and for LC (I:75.7%, II: 92.9%, III:54.1%, IV:100%; p = 0.005). Patients with positive lymph nodes had worse OS (37.9% Vs 70.4%, p = 0.006), DFS (32% Vs 72.7%, p < 0.001) and LC (56.2% Vs 93.4%; p < 0.001).

Conclusion

This study suggests that the neoadjuvant treatment employed was effective for local control. Fixation of the lesion and lymph nodes metastasis were the main adverse prognostic factors. Distant failures were frequent, supporting the need of new drugs for adjuvant chemotherapy.
Appendix
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Metadata
Title
Neoadjuvant radiochemotherapy in the treatment of fixed and semi-fixed rectal tumors. Analysis of results and prognostic factors
Authors
Robson Ferrigno
Paulo Eduardo Ribeiro dos Santos Novaes
Maria Letícia Gobo Silva
Ines Nobuko Nishimoto
Wilson Toshihiko Nakagawa
Benedito Mauro Rossi
Fábio de Oliveira Ferreira
Ademar Lopes
Publication date
01-12-2006
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2006
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/1748-717X-1-5

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