Clinical Research And The Analysis Of Prognostic Factors For Locally Advanced Rectal Cancer With Neoadjuvant Radiotherapy

ObjectiveObserve the efficacy and safety of preoperative concurrent chemoradiotherapy or radiotherapy alone in patients with T3, T4 and lymph node-positive rectal cancer. In addition; observe the efficacy and safety of tomotherapy boost in rectal cancer patients with preoperative concurrent chemoradiotherapy.Materials and MethodsClinical follow-up data on a total of 141 patients with T3, T4 and lymph node-positive rectal cancer who were treated with preoperative concurrent chemoradiotherapy or radiotherapy alone between January 2000 and July 2009 was analysis using SAS 8.0 statistical software. Clinical follow-up data on a total of 42 rectal cancer patients with tomotherapy-boost preoperative concurrent chemoradiotherapy between September 2012 and September 2014 was analysis using SPSS 13.0 statistical software.ResultsIn patients with T3, T4 and lymph node-positive rectal cancer, who treated with preoperative concurrent chemoradiotherapy or radiotherapy alone,the 3-year,5-year overall survival rates were 85.8% and 65.7%,respectively.The 3,5-year local recurrence rates were 9.2% and 14.1%, respectively.The 3,5-year metastasis rates were 33.8% and 45.8%, respectively. The downstaging rate was up to 59.0%(82/139) and the rate of sphincter preservation was 65.5% (91/139).The median PFS in patients treat with preoperative concurrent chemoradiotherapy is superior to radiotherapy alone (51mon vs 31mon, p<0.001). The time to metastasis in patients with downstaging was delayer than that of patients without downstaging (p= 0.0009). Most acute toxicity was grade Ⅰ and Ⅱ. The incidence of delayed wound healing and anastomotic leakage was lower.ConclusionPreoperative concurrent chemoradiotherapy or radiotherapy alone can significantly reduce the tumor stage, and improve the rate of sphincter preservation with tolerated side effects.Compared with common preoperative chemoradiotherapy, TOMOtherapy boost can improve the rate of sphincter preservation and downstaging rate.ObjectiveObserve the efficacy and safety of tomotherapy boost in rectal cancer patients with preoperative concurrent chemoradiotherapy.Materials and MethodsClinical follow-up data on a total of 42 rectal cancer patients with tomotherapy-boost preoperative concurrent chemoradiotherapy between September 2012 and September 2014 was analysis using SPSS 13.0 statistical software.ResultsIn patients with tomotherapy-boost preoperative concurrent chemoradiotherapy,the downstaging rate was up to 78.6%(33/42) and the rate of sphincter preservation was 83.3%(35/42). The platelet/lymph ratio was associated with downstaging (p=0.026). Postoperative pathological CR (pCR) rate was 16.7%(7/42), with pT0 16.7%(7/42) and pN0 73.5%(25/34). The median follow-up time was 15 months (range 4-23 months),2 year disease progression free survival (PFS) rate was 88.1%. Univariate analysis showed that progression free survival time in age< 60 years old patients was significantly lower than≥ 60 years old patients (14.0±2.0 mons vs. 18.0±1.0 mons p=0.025). The majority of toxicity was grade Ⅰ to grade Ⅱ hematological toxicity. Only 1 patient occurred grade Ⅲ neutropenia,2 cases of grade Ⅲ gastrointestinal reaction.Compared with common preoperative chemoradiotherapy, Tomotherapy boost can improve the rate of sphincter preservation (83.3% vs.65.5% x2=4.86, P< 0.05) and downstaging rate (78.6% vs.59% x2=5.34 P< 0.05).ConclusionTomotherapy-boost preoperative concurrent chemoradiotherapy can significantly improve the rate of sphincter preservation and downstaging rate.with tolerated side effects.