Locally Advanced Rectal Cancer: Combined Chemotherapy During Preoperative Radiation Therapy

582 Background: To assess the prognostic impact of total number of retrieved lymph node (TNN) and lymph node radio (LNR) in patients with locally advanced rectal cancer who received preoperative radiation therapy and surgery Methods: We retrospectively analyzed data from 677 patients with locally advanced rectal cancer who underwent preoperative radiation therapy followed by mesorectal excision at Asan Medical Center between October 1999 and May 2009. The median radiation dose was 50 Gy, and 674 patients (99%) underwent concurrent chemotherapy. All patients were divided into two groups according to the status of lymph node involvement. We assessed the influence of TNN on overall survival (OS) and disease-free survival (DFS) in the patients with node-negative disease (pN0, n = 490), and the prognostic value of LNR, estimated by dividing the number of positive nodes by the number of lymph nodes examined, in the patients with node-positive disease (pN1-2, n = 187). Results: The median follow-up period was 74 months.Patients with pN0 had median 12 lymph nodes examined (range, 0-38). Comparing with patients who had ≤ 8 TNN, patients with > 9 TNN had significantly higher 5-year OS (89% vs. 95%, p = 0.038) and DFS rates (81% vs. 90%, p = 0.013). Multivariate analysis showed that TNN more than 9 was significant prognostic factor for OS (p = 0.032) and DFS (p = 0.007). For patients with pN1-2, patients with low LNR (≤ 0.33, n = 144) showed significantly higher 5-year OS (33% vs. 73%, p < 0.001) and DFS rates (18% vs. 56%, p < 0.001) than high LNR group (> 0.33, n = 43). Also, low LNR was independent prognostic factor for OS (p = 0.001) and DFS (p < 0.001) in multivariate analysis. Conclusions: TNN for node-negative rectal cancer and LNR for node-positive rectal cancer are independent prognostic factors for survival outcome in patients with locally advanced rectal cancer after preoperative radiation therapy. These factors could be considered as useful prognostic indicators irrespective of current TNM staging system.

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Biweekly oxaliplatin, raltitrexed, 5-fluorouracil and folinic acid combination chemotherapy during preoperative radiation therapy for locally advanced rectal cancer: a phase I–II study

British Journal of Cancer ◽

10.1038/sj.bjc.6603195 ◽

2006 ◽

Vol 94 (12) ◽

pp. 1809-1815 ◽

Cited By ~ 27

Author(s):

A Avallone ◽

P Delrio ◽

C Guida ◽

F Tatangelo ◽

A Petrillo ◽

...

Keyword(s):

Rectal Cancer ◽

Radiation Therapy ◽

Phase I ◽

Folinic Acid ◽

Combination Chemotherapy ◽

Locally Advanced ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer ◽

Preoperative Radiation ◽

Preoperative Radiation Therapy

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Sphincter preservation in locally advanced rectal cancer due to the addition of continuous infusion 5-FU to preoperative radiation therapy or advances in surgical techniques?

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2004.02.009 ◽

2004 ◽

Vol 59 (2) ◽

pp. 618 ◽

Cited By ~ 2

Author(s):

Toshiaki Watanabe ◽

Hirokazu Nagawa

Keyword(s):

Rectal Cancer ◽

Radiation Therapy ◽

Continuous Infusion ◽

Locally Advanced ◽

Surgical Techniques ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer ◽

Sphincter Preservation ◽

Preoperative Radiation ◽

Preoperative Radiation Therapy

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Postradiation Regression of Locally Advanced Rectal Cancer: Two Clinical Cases

Vestnik of Experimental and Clinical Surgery ◽

10.18499/2070-478x-2021-14-3-221-227 ◽

2021 ◽

Vol 14 (3) ◽

pp. 221-227

Author(s):

Sergey Sergeevich Malev ◽

Ivan Petrovich Moshurov ◽

Dmitry Anatolievich Golovkov ◽

Anastasia Viktorovna Tsurikova ◽

Maxim Borisovich Bykovtsev ◽

...

Keyword(s):

Rectal Cancer ◽

Radiation Therapy ◽

Combined Treatment ◽

Locally Advanced ◽

Neoadjuvant Treatment ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer ◽

Malignant Neoplasms ◽

Complete Regression ◽

Preoperative Radiation

In the Russian Federation, the incidence of malignant neoplasms is more than 50 thousand new cases per year. Since 1990 the combined treatment method is the standard in the treatment of patients with locally advanced rectal cancer. During the evolution of this method, preoperative radiation / chemo-radiation therapy has taken a strong position in the standards for treatment of rectal cancer. Currently, preoperative remote radiation therapy at a dose of 45-52Gy is included in treatment standards for rectal cancer. The main objective of neoadjuvant treatment is to achieve tumor regression. When a complete regression of the tumor is achieved, the task of choosing tactics arises - to carry out surgical treatment, or to apply expectant tactics. In the first clinical case, the patient underwent preoperative chemoradiation treatment with 40.8 Gy combined with capecitabine, after which 4 courses of consolidating chemotherapy were carried out followed by surgery. In the second case, the patient underwent neoadjuvant chemoradiation therapy with 52.5 Gy combined with capecitabine. Given the pronounced positive dynamics, 4 courses of consolidating chemotherapy were performed. After the control study, a complete tumor response to the therapy was revealed. Considering the MRI data and the pronounced positive dynamics, the decision of the multidisciplinary team was the tactics of dynamic observation of the patient.

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