The Efficacy Of Preoperative Chemoradiotherapy In Locally Advanced Rectal Cancer

Objective: To evaluate the short-term and long-term efficacy along with safety of preoperative chemoradiotherapy in locally advanced rectal cancer.Methods: 111 patients diagnosed with locally advanced rectal cancer(clinical stage T3 or T4 and/or node-positive) receiving initial treatment in the Affiliated Hospital of Zunyi Medical College were retrospectively analyzed from Jan 2010 to Jun 2014, of which 29 cases received preoperative chemoradiotherapy, surgery, and postoperative adjuvant therapy were given to observation group, 82 cases accepted surgery followed by adjuvant chemoradiotherapy were performed in control group. All patients underwent radiotherapy was designed to deliver 46-52 Gy of radiation in 23 to 26 times with 1.8-2Gy fractions utilizing five fields pelvic irradiation coupled with s IMRT technique. FOLFOX6 was chosen as the concurrent chemotherapy of the two groups, 1-2 cycles of chemotherapy. Postoperative adjuvant chemotherapy including FOLFOX6, Cape Ox, 2-6 cycles of chemotherapy. Surgery was performed 2-8 weeks after the completion of chemoradiotherapy. To evaluate tumor response after preoperative chemoradiotherapy. The R0 radical resection rate, sphincter preservation rate, overall survival, disease-free survival and cumulative incidence of local recurrence, as well as adverse reaction were compared between the two groups.Results: The median follow-up period was 19 months. A pathological complete response was achieved in 1 patients and partial response in 19 patients of the observation group. The tumor response rate was 65.5 percent. The R0 radical resection rate(79.3% vs 47.6%, P=0.003) and sphincter preservation rate(58.6% vs 35.4%, P=0.047) of observation group were significantly higher than control group. The three-year cumulative incidence of local recurrence was 49 percent for patients assigned to observation group and 77 percent in the control group(P=0.000). No significant differences were detected for three-year overall survival(10.3% vs 13.4%, P=0.918) and disease-free survival(37% vs 29%, P=0.122). From the grade 3 or 4 adverse reactions of chemoradiotherapy in the two groups, The nausea and vomiting(6.9% vs 24.4%, P=0.04), leucopenia(13.8% vs 31.7%, P=0.04) of observation group were significantly lower than control group. There were no significant differences between the two groups of diarrhea and hand-foot syndrome(P respectively as 0.45 and 0.77). There were no significant differences of the two groups of perioperative complications(20.7% vs 29.3%, P=0.371).Conclusion: Preoperative chemoradiotherapy compared with postoperative chemoradiotherapy, significantly increases the rate of R0 radical resection and sphincter preservation, and reduces cumulative incidence of local recurrence rate in the treatment for locally advanced rectal cancer. Treatment-related severe adverse reactions of chemoradiotherapy and perioperative complications are not increased. However, Preoperative chemoradiotherapy does not improve overall survival and disease-free survival.