Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
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Outcomes of Preoperative Chemoradiotherapy and Combined Chemotherapy with Radiotherapy Without Surgery for Locally Advanced Rectal Cancer

  • Supaadirek, Chunsri (Division of Radiotherapy, Department of Radiology, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University) ;
  • Pesee, Montien (Division of Radiotherapy, Department of Radiology, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University) ;
  • Thamronganantasakul, Komsan (Division of Radiotherapy, Department of Radiology, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University) ;
  • Thalangsri, Pimsiree (Division of Radiotherapy, Department of Radiology, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University) ;
  • Krusun, Srichai (Division of Radiotherapy, Department of Radiology, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University) ;
  • Supakalin, Narudom (Division of Radiotherapy, Department of Radiology, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University)
  • Published : 2016.07.01
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Abstract

Purpose: To evaluate the treatment outcomes of patients with locally advanced rectal cancer treated with preoperative concurrent chemoradiotherapy (CCRT) or combined chemotherapy together with radiotherapy (CMT-RT) without surgery. Materials and Methods: A total of 84 patients with locally advanced rectal adenocarcinoma (stage II or III) between January $1^{st}$, 2003 and December $31^{st}$, 2013 were enrolled, 48 treated with preoperative CCRT (Gr.I) and 36 with combined chemotherapy and radiotherapy (CMT-RT) without surgery (Gr.II). The chemotherapeutic agents used concurrent with radiotherapy were either 5-fluorouracil short infusion plus leucovorin and/or capecitabine or 5-fluorouracil infusion alone. All patients received pelvic irradiation. Results: There were 5 patients (10.4%) with a complete pathological response. The 3 year-overall survival rates were 83.2% in Gr.I and 24.8 % in Gr.II (p<0.01). The respective 5 year-overall survival rates were 70.3% and 0% (p<0.01). The 5 year-overall survival rates in Gr.I for patients who received surgery within 56 days after complete CCRT as compared to more than 56 days were 69.5% and 65.1% (p=0.91). Preoperative CCRT used for 12 of 30 patients in Gr.I (40%) with lower rectal cancer demonstrated that in preoperative CCRT a sphincter sparing procedure can be performed. Conclusions: The results of treatment with preoperative CCRT for locally advanced rectal cancer showed comparable rates of overall survival and sphincter sparing procedures as compared to previous studies.

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References

  1. Afzaninawati SY, Zaleha MI, Shamsuk AS (2012). Dietary patterns and risk of colorectal cancer: a systematic review of cohort studies (2000-2011). Asian Pac J Cancer Prev, 13, 4713-7. https://doi.org/10.7314/APJCP.2012.13.9.4713
  2. Bosset JF, Collette L, Calais G, et al (2006). Chemoradiotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med, 355, 1114-23. https://doi.org/10.1056/NEJMoa060829
  3. Bruce D. Minsky, Claus Rodel, Vincenzo Valentini (2012). Rectal cancer. In: textbook of clinical radiation oncology. Eds., Leonard L. Gunderson, Joel E. Tepper, Saunders,an imprint of Elsevier Inc., Philadelphia pp 989-1015.
  4. Bujko K, Nowacki MP, Nasierowska-Guttmacher A, et al (2006). Long Term results of a randomized trial comparing preoperative short-course radiother apy with preoperative conventionally fractionated chemoradiation for rectal cancer. Br J Surg, 93, 1215-23. https://doi.org/10.1002/bjs.5506
  5. Eisenhauer EA, Therasse P, Bogaerts J, et al (2009). New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer, 45, 228-47 https://doi.org/10.1016/j.ejca.2008.10.026
  6. Gerard JP, Conroy T, Bonnetain F, et al (2006). Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-T4 rectal cancers: Results of FFCD 9203. J Clin Oncol, 24, 4620-5. https://doi.org/10.1200/JCO.2006.06.7629
  7. Jeong DH, Lee HB, Hur H, et al (2013).Optimal timing of surgery after neoadjuvant chemoradiation therapy in locally advanced rectal cancer. J Korean Surg Soc, 84, 338-45. https://doi.org/10.4174/jkss.2013.84.6.338
  8. Khuhaprema T, Attasara P, Sriplung H, et al (2013). Cancer in Thailand 2007-2009, Ministry of public Health, Ministry of education, Bangkok, 7, 31.
  9. Khuhaprema T, Srivatanakul P (2008). Colon and rectum cancer in Thailand: an overview. Jpn J Clin Oncol, 38, 237-43. https://doi.org/10.1093/jjco/hyn020
  10. Lee SJ, Kim JG, Lee SW, et al (2013). Clinical implications of initial FDG-PET/CT in locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy. Cancer Chemother Pharmacol, 71, 1201-7. https://doi.org/10.1007/s00280-013-2114-0
  11. Moghimi-Dehkordi B, Safaee A, Zali MR (2008). Prognostic factors in 1,138 Iranian colorectal cancer patients. Int J Colorectal Dis, 23, 683-8. https://doi.org/10.1007/s00384-008-0463-7
  12. Mostafa AA, Mostafa IW , Sahar J, et al (2011). Dietary and lifestyle characteristics of colorectal cancer in Jordan : a case-control study. Asian Pac J Cancer Prev, 12, 1931-6.
  13. Park JH, Yoon SM, Yu CS, et al (2011). Randomized phase 3 trial comparing preoperative and postoperative chemoradiotherapy with capecitabine for locally advanced rectal cancer. Cancer, 117, 3703-12. https://doi.org/10.1002/cncr.25943
  14. Park YJ, Park KJ, Park JG, et al (1999). Prognostic factors in 2230 Korean colorectal cancer patients: analysis of consecutively operated cases. World J Surg, 23, 721-6. https://doi.org/10.1007/PL00012376
  15. Pichayada D, Putipun P, Mantana D, et al (2015). Long term outcomes of preoperative versus postoperative concurrent chemoradiation for locally advanced rectal cancer : experience from Ramathibodi medical school in Thailand, Asian Pac J Cancer Prev, 16, 7315-9. https://doi.org/10.7314/APJCP.2015.16.16.7315
  16. Roh MS, Colangelo LH, O'Connell MJ, et al (2009). Preoperative multimodality therapy improves disease-free survival in patients with carcinoma of the rectum: NSABP R-03. J Clin Oncol, 27, 5124-30. https://doi.org/10.1200/JCO.2009.22.0467
  17. Safaee A, Moghimi-Dehkordi B, Fatemi SR, et al (2008). Colorectal cancer in Iran : an epidemiological study. Asian Pac J Cancer Prev, 9, 123-6.
  18. Sauer R, Becker H, Hohenberger W, et al (2004). Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med, 351, 1731-40. https://doi.org/10.1056/NEJMoa040694
  19. Shiono S, Ishii G, Nagai K, et al (2005). Histopathologic prognostic factors in resected colorectal lung metastases. Ann Thorac Surg, 79, 278-82. https://doi.org/10.1016/j.athoracsur.2004.06.096
  20. Sriplung H, Wiangnon S, Sontipong S, et al (2006). Cancer incidence trends in Thailand, 1989-2000. Asian Pac J Cancer Prev, 7, 118-25.
  21. Suwanrungruang K, Wiangnon S, Sriamporn S, et al (2006). Trends in incidences of stomach and colorectal cancer in Khon Kaen, Thailand 1985-2004. Asian Pac J Cancer Prev, 7, 623-6.
  22. Terek TA, Waseem S, Abdul AT, et al (2012). Patients'profile, clinical presentations and histopathological features of colorectal cancer in AI Hassa region, Saudi Arabia, Asian Pac J Cancer Prev, 13, 211-6. https://doi.org/10.7314/APJCP.2012.13.1.211
  23. Yang SH, Lee RC, Chen CC, et al (2005). Is decrease of tumor volume correlated with stage change after preoperative concurrent chemoradiotherapy. Hepatogastroenterol, 52, 765-9.