Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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Comparison between preoperative and postoperative concurrent chemoradiotherapy for rectal cancer: an institutional analysis

  • Lee, Jeong Won (Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Lee, Jong Hoon (Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Kim, Jun-Gi (Department of Colorectal Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Oh, Seong Taek (Department of Colorectal Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Chung, Hyuk Jun (Department of Colorectal Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Lee, Myung Ah (Department of Medical Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Chun, Hoo Geun (Department of Medical Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Jeong, Song Mi (Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Yoon, Sei Chul (Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Jang, Hong Seok (Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine)
  • Received : 2013.06.10
  • Accepted : 2013.09.06
  • Published : 2013.09.30
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Abstract

Purpose: To evaluate the treatment outcomes of preoperative versus postoperative concurrent chemoradiotherapy (CRT) on locally advanced rectal cancer. Materials and Methods: Medical data of 114 patients with locally advanced rectal cancer treated with CRT preoperatively (54 patients) or postoperatively (60 patients) from June 2003 to April 2011 was analyzed retrospectively. 5-Fluorouracil (5-FU) or a precursor of 5-FU-based concurrent CRT (median, 50.4 Gy) and total mesorectal excision were conducted for all patients. The median follow-up duration was 43 months (range, 16 to 118 months). The primary end point was disease-free survival (DFS). The secondary end points were overall survival (OS), locoregional control, toxicity, and sphincter preservation rate. Results: The 5-year DFS rate was 72.1% and 48.6% for the preoperative and postoperative CRT group, respectively (p = 0.05, the univariate analysis; p = 0.10, the multivariate analysis). The 5-year OS rate was not significantly different between the groups (76.2% vs. 69.0%, p = 0.23). The 5-year locoregional control rate was 85.2% and 84.7% for the preoperative and postoperative CRT groups (p = 0.98). The sphincter preservation rate of low-lying tumor showed significant difference between both groups (58.1% vs. 25.0%, p = 0.02). Pathologic tumor and nodal down-classification occurred after the preoperative CRT (53.7% and 77.8%, both p < 0.001). Acute and chronic toxicities were not significantly different between both groups (p=0.10 and p = 0.62, respectively). Conclusion: The results confirm that preoperative CRT can be advantageous for improving down-classification rate and the sphincter preservation rate of low-lying tumor in rectal cancer.

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References

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