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http://dx.doi.org/10.3857/jkstro.2011.29.1.11

The Pathological and Clinical Effects of Preoperative Chemoradiation in Rectal Cancer  

Song, Jin-Ho (Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea School of Medicine)
Jang, Hong-Seok (Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea School of Medicine)
Kim, Yeon-Sil (Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea School of Medicine)
Chung, Su-Mi (Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea School of Medicine)
Son, Seok-Hyun (Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea School of Medicine)
Kang, Jin-Hyeong (Department of Medical Onocology, Seoul St. Mary's Hospital, The Catholic University of Korea School of Medicine)
Youk, Eui-Gon (Department of Colorectal Surgery, Daehang Hospital)
Lee, Doo-Seok (Department of Colorectal Surgery, Daehang Hospital)
Lee, Suk-Hi (Department of Clinical Pathology, Daehang Hospital)
Yoon, Sei-Chul (Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea School of Medicine)
Publication Information
Radiation Oncology Journal / v.29, no.1, 2011 , pp. 11-19 More about this Journal
Abstract
Purpose: To evaluate the pathological and clinical effects of preoperative chemoradiation (CCRT) in cases of locally advanced rectal cancer and to determine the predictive factors for tumor downstaging. Materials and Methods: From March 2004 to August 2008, 33 patients with locally advanced rectal cancer were treated with preoperative CCRT. Twenty-eight patients (84.8%) were treated using a concomitant boost technique while five (15.2%) patients were treated using a cone down boost technique. All patients received 50.4 Gy of irradiation and concurrent chemotherapy with 5-fluorouracil. The median follow-up duration was 24.2 months (range, 9.8 to 64.7 months). Results: Thirty-one (93.9%) patients underwent surgery. Twenty-four patients (72.7%) underwent anal sphincter-preserving surgery. The 3-year disease free survival (DFS) and overall survival rates were 63.4% and 78.8%, respectively. Post-operative factors were more important for DFS. Pathologic N stage, margin status, and pathologic differentiation were significant prognostic factors (p=0.001, 0.029, 0.030). Tumor size and lymphovascular invasion were also associated with marginal significance (p=0.081, 0.073). However, only pre-treatment T stage was a significant pre-operative factor (p=0.018). The complete pathological response rate was 9.1 %. T-downstaging was observed in ten (30.3%) patients, whereas N-downstaging was found in 24 (72.7%) patients. Pre-treatment T stage and the interval between CCRT and operation were the predictive factors for downstaging in a univariate analysis (p=0.029, 0.027). Pre-treatment carcinoembryogenic antigen was also associated with marginal significance (p=0.068). Conclusion: The survival of rectal cancer patients can be better determined based on post-operative findings. Therefore, pre-operative CCRT for downstaging of the tumor seems to be important. Pre-treatment T stage and the interval between CCRT and operation can be used to predict downstaging.
Keywords
Rectal cancer; Preoperative concurrent chemoradiation; Concomitant boost technique;
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1 Swedish Rectal Cancer Trial. Improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med 1997;336:980-987   DOI   ScienceOn
2 Martling A, Holm T, Johansson H, Rutqvist LE, Cedermark B; Stockholm Colorectal Cancer Study Group. The Stockholm II trial on preoperative radiotherapy in rectal carcinoma: long-term follow-up of a population-based study. Cancer 2001;92:896-902   DOI   ScienceOn
3 Camma C, Giunta M, Fiorica F, Pagliaro L, Craxi A, Cottone M. Preoperative radiotherapy for resectable rectal cancer: a meta-analysis. JAMA 2000;284:1008-1015   DOI   ScienceOn
4 Gerard JP, Conroy T, Bonnetain F, et al. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers: results of FFCD 9203. J Clin Oncol 2006;24:4620-4625   DOI   ScienceOn
5 Bosset JF, Collette L, Calais G, et al. Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 2006;355:1114-1123   DOI   ScienceOn
6 Gerard JP, Chapet O, Nemoz C, et al. Improved sphincter preservation in low rectal cancer with high-dose preoperative radiotherapy: the lyon R96-02 randomized trial. J Clin Oncol 2004;22:2404-2409   DOI   ScienceOn
7 Chan AK, Wong A, Jenken D, Heine J, Buie D, Johnson D. Posttreatment TNM staging is a prognostic indicator of survival and recurrence in tethered or fixed rectal carcinoma after preoperative chemotherapy and radiotherapy. Int J Radiat Oncol Biol Phys 2005;61:665-677   DOI   ScienceOn
8 Bosset JF, Calais G, Mineur L, et al. Enhanced tumorocidal effect of chemotherapy with preoperative radiotherapy for rectal cancer: preliminary results-EORTC 22921. J Clin Oncol 2005;23:5620-5627   DOI   ScienceOn
9 National Comprehensive Cancer Network. Clinical practice guidelines in oncology V. 2. 2009: Rectal cancer. Fort Washington, PA: National Comprehensive Cancer Network; c2011 [cited 2011 Jan 30]. Available from: http://www.nccn.org/professionals/physician_gls/PDC/rectal.pdf
10 Yoon MS, Nam TK, Kim HR, et al. Results of preoperative concurrent chemoradiotherapy for the treatment of rectal cancer. J Korean Soc Ther Radiol Oncol 2008;26:247-256   DOI
11 Rosenberg R, Nekarda H, Zimmermann F, et al. Histopathological response after preoperative radiochemotherapy in rectal carcinoma is associated with improved overall survival. J Surg Oncol 2008;97:8-13   DOI   ScienceOn
12 Capirci C, Valentini V, Cionini L, et al. Prognostic value of pathologic complete response after neoadjuvant therapy in locally advanced rectal cancer: long-term analysis of 566 ypCR patients. Int J Radiat Oncol Biol Phys 2008;72:99-107   DOI   ScienceOn
13 Rullier A, Laurent C, Capdepont M, et al. Impact of tumor response on survival after radiochemotherapy in locally advanced rectal carcinoma. Am J Surg Pathol 2010;34:562-568   DOI   ScienceOn
14 Kim DY, Kim TH, Jung KH, et al. Preoperative chemoradiotherapy with concomitant small field boost irradiation for locally advanced rectal cancer: a multi-institutional phase II study (KROG 04-01). Dis Colon Rectum 2006;49:1684-1691   DOI   ScienceOn
15 Saif MW, Hashmi S, Zelterman D, Almhanna K, Kim R. Capecitabine vs continuous infusion 5-FU in neoadjuvant treatment of rectal cancer: a retrospective review. Int J Colorectal Dis 2008;23:139-145   DOI   ScienceOn
16 De Paoli A, Chiara S, Luppi G, et al. Capecitabine in combination with preoperative radiation therapy in locally advanced, resectable, rectal cancer: a multicentric phase II study. Ann Oncol 2006;17:246-251   DOI
17 Lee J, Kang HC, Chie EK, et al. Effect of suboptimal chemotherapy on preoperative chemoradiation in rectal Cancer. J Korean Soc Ther Radiol Oncol 2009;27:78-83   DOI
18 Das P, Skibber JM, Rodriguez-Bigas MA, et al. Predictors of tumor response and downstaging in patients who receive preoperative chemoradiation for rectal cancer. Cancer 2007;109:1750-1755   DOI   ScienceOn
19 National Cancer Information Center. Cancer statistics, 2007. Goyang: National Cancer Information Center; [cited 2011 Jan 30]. Available from: http://www.cancer.go.kr/cms/statics/incidence
20 Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2008. CA Cancer J Clin 2008;58:71-96   DOI   ScienceOn
21 Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004;351:1731-1740   DOI   ScienceOn
22 Yoon SM, Kim DY, Kim TH, et al. Clinical parameters predicting pathologic tumor response after preoperative chemoradiotherapy for rectal cancer. Int J Radiat Oncol Biol Phys 2007;69:1167-1172   DOI   ScienceOn
23 Kim JS, Kim JM, Li S, et al. Epidermal growth factor receptor as a predictor of tumor downstaging in locally advanced rectal cancer patients treated with preoperative chemoradiotherapy. Int J Radiat Oncol Biol Phys 2006;66:195-200   DOI   ScienceOn
24 Smith FM, Reynolds JV, Kay EW, et al. COX-2 overexpression in pretreatment biopsies predicts response of rectal cancers to neoadjuvant radiochemotherapy. Int J Radiat Oncol Biol Phys 2006;64:466-472   DOI   ScienceOn
25 Capirci C, Valentini V, Cionini L, et al. Prognostic value of pathologic complete response after neoadjuvant therapy in locally advanced rectal cancer: long-term analysis of 566 ypCR patients. Int J Radiat Oncol Biol Phys 2008;72:99-107   DOI   ScienceOn
26 O'Connell MJ, Martenson JA, Wieand HS, et al. Improving adjuvant therapy for rectal cancer by combining protracted-infusion fluorouracil with radiation therapy after curative surgery. N Engl J Med 1994;331:502-507   DOI   ScienceOn
27 Berger C, de Muret A, Garaud P, et al. Preoperative radiotherapy (RT) for rectal cancer: predictive factors of tumor downstaging and residual tumor cell density (RTCD): prognostic implications. Int J Radiat Oncol Biol Phys 1997;37:619-627   DOI   ScienceOn
28 Mohiuddin M, Regine WF, John WJ, et al. Preoperative chemoradiation in fixed distal rectal cancer: dose time factors for pathological complete response. Int J Radiat Oncol Biol Phys 2000;46:883-888   DOI   ScienceOn
29 Crane CH, Sargent DJ. Substitution of oral fluoropyrimidines for infusional fluorouracil with radiotherapy: how much data do we need? J Clin Oncol 2004;22:2978-2981   DOI   ScienceOn
30 Smalley SR, Benedetti JK, Williamson SK, et al. Phase III trial of fluorouracil-based chemotherapy regimens plus radiotherapy in postoperative adjuvant rectal cancer: GI INT 0144. J Clin Oncol 2006;24:3542-3547   DOI   ScienceOn
31 Saif MW, Hashmi S, Zelterman D, Almhanna K, Kim R. Capecitabine vs continuous infusion 5-FU in neoadjuvant treatment of rectal cancer: a retrospective review. Int J Colorectal Dis 2008;23:139-145   DOI   ScienceOn
32 Gerard JP, Azria D, Gourgou-Bourgade S, et al. Comparison of two neoadjuvant chemoradiotherapy regimens for locally advanced rectal cancer: results of the phase III trial ACCORD 12/0405-Prodige 2. J Clin Oncol 2010;28:1638-1644   DOI   ScienceOn
33 Mehta VK, Cho C, Ford JM, et al. Phase II trial of preoperative 3D conformal radiotherapy, protracted venous infusion 5-fluorouracil, and weekly CPT-11, followed by surgery for ultrasound-staged T3 rectal cancer. Int J Radiat Oncol Biol Phys 2003;55:132-137   DOI   ScienceOn
34 Glynne-Jones R, Sebag-Montefiore D, Maughan TS, Falk SJ, McDonald AC. A phase I dose escalation study of continuous oral capecitabine in combination with oxaliplatin and pelvic radiation (XELOX-RT) in patients with locally advanced rectal cancer. Ann Oncol 2006;17:50-56   DOI
35 Lee J, Lee KJ. Clinical factors predicting the pathologic tumor response after preoperative concurrent chemoradio-therapy for rectal cancer. J Korean Soc Ther Radiol Oncol 2008;26:213-221   DOI
36 Choi SG, Kim SS, Bae HS. Results of preoperative concurrent chemoradiotherapy for locally advanced rectal cancer. J Korean Soc Ther Radiol Oncol 2007;25:34-42
37 Fisher B, Wolmark N, Rockette H, et al. Postoperative adjuvant chemotherapy or radiation therapy for rectal cancer: results from NSABP protocol R-01. J Natl Cancer Inst 1988;80:21-29   DOI
38 Wolmark N, Wieand HS, Hyams DM, et al. Randomized trial of postoperative adjuvant chemotherapy with or without radiotherapy for carcinoma of the rectum: National Surgical Adjuvant Breast and Bowel Project Protocol R-02. J Natl Cancer Inst 2000;92:388-396   DOI