When a rare simultaneous infection simulates a local extension of a rectal cancer: a case report

Abstract Background Actinomycosis is a rare chronic infection caused by Actinomyces. The abdominopelvic localization of this pathology makes preoperative diagnosis extremely exceptional. The following report is the case of a patient treated for adenocarcinoma of the middle rectum associated with mesorectal actinomycosis. The diagnosis of actinomycosis was made postoperatively. Case presentation A 69-year-old Caucasian male patient was admitted for rectal bleeding. Clinical and paraclinical assessment revealed a middle rectum adenocarcinoma with local extension in the mesorectum. The patient underwent an anterior resection of the rectum by laparotomy after neoadjuvant chemoradiotherapy. Postoperative follow-up was simple. Pathological study of the specimen noted complete sterilization of the rectal adenocarcinoma and the presence of large foci of suppurative necrosis containing actinomycotic grains in the mesorectum. Conclusion Abdominopelvic actinomycosis is a rare pathology and has therefore rarely been dealt with. This issue can lead to unnecessary and mutilating surgery. We report an exceptional coincidence of rectal adenocarcinoma and mesorectal actinomycosis mistaken for mesorectal extension of the cancer.

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Impact of biomarker dynamic profile and pathological response induced by neoadjuvant chemoradiotherapy in rectal cancer

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.3614 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 3614-3614

Author(s):

A. L. Gentile ◽

C. Pinto ◽

C. Ceccarelli ◽

F. Di Fabio ◽

C. Funaioli ◽

...

Keyword(s):

Rectal Cancer ◽

Neoadjuvant Therapy ◽

Neoadjuvant Treatment ◽

Rectal Adenocarcinoma ◽

Neoadjuvant Chemoradiotherapy ◽

Rectal Surgery ◽

Pathological Response ◽

Resection Margins ◽

Tumor Regression Grade ◽

Operative Specimen

3614 Background: The aim of this study was to evaluate the correlation among biomarkers, pathological response and clinical outcomes in patients (pts) with rectal cancer submitted to neoadjuvant chemoradiotherapy. Methods: Pts entering the study had rectal adenocarcinoma, uT3/4N-/+ or uT2N-/+ with inferior location. Chemotherapy consisted of oxaliplatin 60 mg/m2 weekly infusion IV for 6 times and 5-fluorouracil 225 mg/m2/die continuous infusion IV d 1–38. Radiotherapy was delivered up to a dose of 50.4 Gy in daily fractions of 1.8 Gy d 1–38. Rectal surgery with TME was performed 6–8 weeks after neoadjuvant treatment. Immunohistochemical determination of Ki67, p53, bcl2, TS, EGFR, MLH1 and MSH2 was performed in pretreatment biopsy and operative specimen. Results: Between March 2002 and May 2005, 32 pts had completed neoadjuvant therapy and surgery. Pt characteristics: 24 (75%) men and 8 (25%) women; median age 64 (33–80) years; stage uT2N-M0 3 (9.4%) pts, uT3N-M0 14 (43.8%), uT3N+M0 10 (31.2%), uT3NXM0 2 (6.2%), uT4N+M0 3 (9.4%). Surgery consisted of abdominal-perineal amputation in 12 (37.5%) and low-anterior resection in 17 (53.1%) pts, with negative circumferential resection margins in 86.2%. Laparoscopic local excision was performed in 3 (9.4%) pts. Pathological down-staging occurred in 18 (56.2%) pts, including 7 (21.9%) pT0N0, with sphincter preservation in 40%. Tumor Regression Grade (TRG) (according to Mandard) evaluation of operative specimen was: 7 TRG1, 11 TRG2, 11 TRG3 and 3 TRG4. Expression mean value in pretreatment biopsy and operative specimen was: Ki67 88.8% and 31.7%; p53 49.7% and 40.7%; TS 12.6% and 10.0%; MLH1 89.7% and 76.4%; MSH2 84.3% and 72.2%. The evaluation of biomarker profile in operative specimen of TRG2 pts vs TRG3–4 showed: Ki67 16.6% vs 46.2% (p=0.03); TS 4.5% vs 12.9% (ns); MSH2 82.3% vs 65.6% (ns); p53 52.3% vs 34.8% (ns). Median DFS was 19 (3–35) months. At a median follow-up of 22 (5–41) months, 100.0% of TRG1 pts, 90.9% of TRG2, 73.3% of TRG3–4 had no-evidence of disease relapse. Conclusions: These preliminary results suggest a correlation between Ki67 and pathological response in rectal cancer pts treated with neoadjuvant therapy. Moreover, DFS appears to be related to TRG. No significant financial relationships to disclose.

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Neoadjuvant chemoradiotherapy in rectal cancer patients (pt) with oxaliplatin (Ox) and capecitabine (Cp): Results of a phase II trial

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e15101 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e15101-e15101

Author(s):

J. Gasent Blesa ◽

V. Alberola Candel ◽

O. Juan ◽

M. Provencio Pulla ◽

V. Giner Marco ◽

...

Keyword(s):

Neoadjuvant Treatment ◽

Rectal Adenocarcinoma ◽

Neoadjuvant Chemoradiotherapy ◽

Preoperative Chemoradiotherapy ◽

Sphincter Preservation ◽

Pathological Result ◽

Complete Treatment ◽

Tumor Downstaging ◽

The Mean

e15101 Background: Between April 2006 and May 2008, 27 rectal adenocarcinoma pt were included (cT3: 25 pt, T4: 2 pt, N0: 11 Pt, N+: 16 pt), stages II-III, RMN staged, 14 male and 13 female. Mehtod: Neoadjuvant treatment was: Ox: 50 mg/m2 weekly, oral Cp: 825 mg/m2 tid the days of the Rt, and a Rt of 50.4 Gy. 9 pt had a lower third tumor, 9 middle, 9 upper. Surgery was planned 6–8 weeks after treatment´s end. 4 adjuvant chemotherapy cycles with Xelox were planned. Results: 7 pt had pCR (26%), 2 pt progression disease 18 pt tumor downstaging(dwst). Percentages of dwst were: T 85%, N 37%. Sphincter preservation (sp) was 81.9%, for tumors of the lower third sp was 44.4%. Presurgical (prsrg) RMN did not predict the pathological result in 21 pt. Main side effects: Dermatitis G1 in 21 pt, and G2 in 4 pt. Diarrhea 12 pt G1, 11 pt G2, and 4 pt G3. Hand and foot G1 5 Pt and G2 4 pt. Paresthesias G1 10 pt, G2 7 pt. Leucopenia 6 pt G1. 4 Pt did not complete treatment because of toxicity. Median Rt dose was 49.7 Gy (47.5–50.4 Gy).At a mean follow up of 22.5 months (7–31) 4 pt presented metastatic disease (15% ), none in the pCR group. Mean pre-neoadjuvant (preneo) CEA was 6.8 ng/ml (2.1–17.0). There was difference statistically significant when compared preneo CEA vs prsrg CEA: 2.72 ng/ml inferior with the second outcome (p<0.001). Mean prsurg CEA was 4.1 (0.1–12.0). In the subgroup with pCR the mean prsrg CEA was 1.1 (0.5–1.5), and in non-pCR it was 5.1 (0.1–12.0). Comparing the prsrg CEA between pCR and the non-pCR subgroups, the mean difference was 4.0 ng/ml greater in the non pCR. This difference was statistically significant (p=0.002, 95% CI: 1.68–6.3).We found a nadir of <5ng/ml as significantly associated with pCR (p=0.036). Conclusions: Preoperative chemoradiotherapy with Ox and Cp, is safe and well tolerated. Offers an interesting ratio of pCR, and of tumor downstaging. Prsrg CEA level and CEA nadir should be studied as predictors of pCR. It is possible that with more patients, the significant nadir level could be lower. We consider this combination and the CEA nadir interesting to be included in further studies. No significant financial relationships to disclose.

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Polymorphisms of thymidylate synthase as prognostic factor in rectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.4_suppl.433 ◽

2011 ◽

Vol 29 (4_suppl) ◽

pp. 433-433

Author(s):

V. Arrazubi ◽

J. Suarez ◽

D. Guerrero ◽

K. Cambra ◽

M. L. Gomez Dorronsoro ◽

...

Keyword(s):

Rectal Cancer ◽

Thymidylate Synthase ◽

Locally Advanced ◽

Neoadjuvant Chemoradiotherapy ◽

Disease Free Survival ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer ◽

Tumour Regression ◽

The Difference

433 Background: Neoadjuvant fluoropyrimidine-based chemotherapy (ChT) plus radiotherapy (Rt) is a standard approach for locally advanced rectal cancer. Polymorphisms of thymidylate synthase (TS), the target for fluoropyrimidines, are recognized prognostic factors in colon cancer. The aim of this study was to evaluate the prognostic value of the polymorphisms of TS in rectal cancer after neoadjuvant ChT plus Rt. Methods: We studied one-hundred consecutive patients with stage II/III rectal cancer between November 2001 and March 2009. Patients underwent surgery 6-8 weeks after neoadjuvant Rt (5,040 cGy) plus fluoropyrimidine-based ChT. DNA was extracted from paraffin embedded biopsies. TS1494del6 and 5′-28bp repeat +G/C SNP polymorphisms were determined. Results: Sixty-seven percent were men and median age was 67 years. ypT stage was: T0 9%, T1 2%, T2 27%, T3 60% and T4 2%; 32% had locoregional adenopathies. The median follow-up was 45 months and relapse occurred in 20% of patients. Polimorphisms could be determined in 98% of pt: -6bp/-6bp 10%, - 6bp/+6bp 39%, +6bp/+6bp 51% and 2R/2R 72%, 2R/3R 21%, 3R/3R 6%. The grade of pathological tumour regression was not associated with polymorphisms. Relapses occurred in 40% of patients -6bp/-6bp, 22% of patients -6bp/+6bp and 21% of patients +6bp/+6bp. The difference in disease- free survival (DFS) between the first and the third groups was stadistically significative (p=0.049). No relation between 5′-28bp repeat +G/C SNP polymorphism and DFS was found. Conclusions: Our data suggest that the TS1494del6 polimorphism may be an important prognosis factor in rectal cancer receiving neoadjuvant chemoradiotherapy. No significant financial relationships to disclose.

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Positron emission tomography-computed tomography (PET-CT) for the assessment of pathologic response to neoadjuvant chemoradiotherapy in rectal adenocarcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.4_suppl.537 ◽

2013 ◽

Vol 31 (4_suppl) ◽

pp. 537-537

Author(s):

Noman Ashraf ◽

Saqib Razzaque ◽

Ben C. Creelan ◽

Julio C. Chavez ◽

David Shibata ◽

...

Keyword(s):

Overall Survival ◽

Locally Advanced ◽

Pathologic Complete Response ◽

Rectal Adenocarcinoma ◽

Neoadjuvant Chemoradiotherapy ◽

Standardized Uptake Value ◽

Neoadjuvant Chemoradiation ◽

Significant Trend ◽

Pet Ct

537 Background: Preoperative 5-fluorouracil and radiation (FU-XRT) has been demonstrated to improve recurrence-free survival in locally advanced rectal adenocarcinoma, however the role of interval PET-CT remains unclear. We performed a retrospective study with the primary objective of examining the association of change in standardized uptake value (SUV) by PET-CT after neoadjuvant chemoradiation and pathologic complete response (path CR) to survival. Methods: Data was extracted for cases at our institution between August 2006–August 2009, with last follow-up performed July 2012. Patients were included if (i) they had completed a full course of preoperative FU-XRT, followed by surgery with intent for R0 resection, and (ii) pre- and post- therapy PET-CT as well as pathologic reports were available for review. Data was compared by Fischer's exact and Wilcoxon rank-sum, and survival was analyzed using Kaplan-Meier method. Clinicopathologic data was compared by log-rank test and univariate Cox proportional hazards for relationship to overall survival (OS). Results: Of 128 total rectal cancer cases reviewed, 25 (19%) met inclusion criteria. Characteristics of 25 patients included: 13 female, age 57± 14 years (median ± SD). After 116 patient-years of follow-up, median OS was not reached; mean OS was 4.6 ± 0.9 years. Mean baseline pre-treatment PET SUV (18.5 ± 9.1) decreased after neoadjuvant FU-XRT (5.0 ± 4.3, p < 0.0001). Five achieved path CR. Presence of earlier stage was associated with non-significant trend towards improved chance of pathologic CR (RR 3.1, p = 0.07). A decrease in PET SUV by 80% or more was associated with improved odds of path CR (OR 25, 95% CI 1.2 - 513, p = 0.009), and was also associated with a non-significant trend towards improved OS (HR 0.19, 95% CI 0.01 - 2.7). Path CR was associated with a non-statistically significant trend to improved overall survival (HR 0.28, 95% CI 0.01 - 8.4). Conclusions: Reduction in PET-CT SUV after neoadjuvant chemoradiation may be a useful predictor of pathologic CR in rectal adenocarcinoma. These exploratory findings need to be validated in larger prospective studies.

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Chemoradiation-induced alteration of programmed death-ligand 1 and CD8+ tumor-infiltrating lymphocytes in rectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.4_suppl.570 ◽

2019 ◽

Vol 37 (4_suppl) ◽

pp. 570-570

Author(s):

Marina Baretti ◽

Wei Fu ◽

Hao Wang ◽

Robert A Anders ◽

Nilofer Saba Azad ◽

...

Keyword(s):

Rectal Cancer ◽

Checkpoint Inhibitors ◽

Rectal Adenocarcinoma ◽

Neoadjuvant Chemoradiotherapy ◽

Tumor Infiltrating Lymphocytes ◽

Tumor Stroma ◽

Immune Checkpoints ◽

Mucin Expression ◽

Significant Difference ◽

Potential Applicability

570 Background: DNA damage and subsequent neoantigen formation has been hypothesized as a mechanismfor radiotherapy and PD-1/PD-L1 pathway inhibition to synergize in an antitumor immune response. We investigated neoadjuvant chemoradiotherapy (nCRT)-induced changes in CD8+ tumor infiltrating lymphocyte, PD-L1 and mucin expression in rectal cancer patients as compared to patients who did not receive nCRT. Methods: Tumor samples were collected from rectal adenocarcinoma patients who had undergone resection between 2008-2014 with (n = 62) or without (n = 17) nCRT treatment. Tissue sections were stained with CD8 and PD-L1 antibodies for immunohistochemistry. Whole slides images were acquired at 20x magnification. The prevalence of positive CD8 stained cells was recorded in tumor, interface tumor side, interface background rectal side. Image analysis (HALO Indica Labs) was used to determine the density (# of cells/surface area analyzed) of CD8 expressing lymphocytes. The percentage of PD-L1 membranous expression was manually counted in tumor cells (TC), tumor stroma (TS) and invasive front (IF). Mucin expression was determined as the percentage of the mucin area in the whole tumor mass area. Results: PD-L1 expression on TCs was identified in 7.7 % (6/78) of specimens. All 6 cases had received nCRT (p = 0.33). 80% and 75.5% of the nCRT cases showed PD-L1 expression on TS and IF respectively, versus 20% (p = 0.55) and 24.5% (p = 0.56) in non-nCRT cases. The median densities of CD8+ infiltrating T lymphocytes in tumor, interface tumor side, interface background rectal side did not differ significantly between the two groups (p = 0.79, p = 0.47, p = 0.22). No nCRT-changes in mucin expression observed in the 28 evaluable cases (p = 0.25). Conclusions: nCRT exposure was associated with a non-significant difference in PD-L1 expression on TS and IF cells in patients with rectal adenocarcinoma as compared to non-nCRT case, possibly due to sample size limitations. Further mechanistic investigations and comprehensive analysis of other immune checkpoints are needed to understand nCRT-induced immunologic shift in rectal cancer and to expand the potential applicability of checkpoint inhibitors in this setting.

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Metachronous Bilateral Isolated Adrenal Metastasis from Rectal Adenocarcinoma: A Case Report

Case Reports in Gastrointestinal Medicine ◽

10.1155/2014/516403 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

H. Jabir ◽

N. Tawfiq ◽

M. Moukhlissi ◽

M. Akssim ◽

A. Guensi ◽

...

Keyword(s):

Colorectal Cancer ◽

Computed Tomography ◽

Rectal Cancer ◽

Histopathological Examination ◽

Rectal Adenocarcinoma ◽

Adrenal Metastasis ◽

Computed Tomography Scan ◽

Serum Carcinoembryonic Antigen ◽

Tomography Scan

We report a case of adrenal metastasis from colorectal cancer in a 54-year-old woman. Nine months after resection for advanced rectal carcinoma, a computed tomography scan revealed bilateral adrenal metastasis. The level of serum carcinoembryonic antigen was normal. A bilateral adrenalectomy was performed after chemotherapy. Histopathological examination showed adenocarcinoma, compatible with metastasis from the rectal cancer. Adrenal metastasis should be considered in the patients’ follow-up for colorectal cancer.

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Treatment of diatal rectal cancer with preoperative intensity-modulated radiation therapy (IMRT) combined with chemotherapy: Updated 5-year results of 42 patients.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e14157 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e14157-e14157

Author(s):

Albert S. DeNittis ◽

John Marks ◽

Filip Troicki ◽

Erik L. Zeger ◽

George Nassif ◽

...

Keyword(s):

Rectal Cancer ◽

Overall Survival ◽

Radiation Therapy ◽

Local Control ◽

Medical Center ◽

Neoadjuvant Chemoradiotherapy ◽

Intensity Modulated Radiation Therapy ◽

Intensity Modulated ◽

Distal Rectal Cancer

e14157 Background: Preoperative chemoradiotherapy is currently the standard of care for patients with distal rectal cancer. With Intensity Modulated Radiation Therapy (IMRT), more conformal doses of radiation can be delivered to tumor while sparing normal tissue. It is our intent to present updated data showing 5 year follow up on patients treated concurrently with chemotherapy and IMRT reporting on local control, overall survival, and toxicity. Methods: From April 2007 to February of 2012 a sequential retrospective study of 42 patients at Lankenau Medical Center were treated for distal rectal cancer using IMRT. Patients staged from T2N0M0 to T3N1M0 and all received 5580 cGy to the pelvis using a 9 field plan to tumor, involved and uninvolved lymph nodes. All but one patient received 5FU based chemotherapy and four patients also received oxaliplatin. All patients then went on to surgery 8 – 12 weeks following neoadjuvant therapy. Twenty six patients underwent transabdominal transanal mesorectal (TATA) resection, 9 patients underwent a transanal endoscopic microsurgery (TEM), and 1 patient had an open low anterior resection. 3 patients have yet to go to surgery. FOLFOX was given to 25 of 42 patients adjuvently. Patients were analyzed for local control (LC), median survival (MS), overall survival (OS), and toxicity. Results: The median follow-up was 35 months. Complete pathological response was achieved in 12 (30.7%) patients, partial response was achieved in 25 (64%) patients, and 2 had stable disease at the time of surgery. There were no patients with local failure and only six (14%) patients progressed with distant metastatic disease. OS at 5 years was 92.8% with a MS of 37 months. Toxicity was acceptable with eight patients with grade 1, 5 patients with grade 2, and 3 grade 3 diarrhea. There were 3 (7%) patients with grade 1 neutropenia. Three patients experienced disease related death. Conclusions: With 5 years of follow-up data, our experience has shown that neoadjuvant chemoradiotherapy using IMRT to treat advanced stage rectal cancer is well tolerated and effective. Still further follow-up and additional studies will be required to confirm our findings.

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Oncologic Outcomes of ypT1-3N0 mid-Low Rectal Cancer Compared with pT1-3N0 Disease After Radical Resection

10.21203/rs.3.rs-72204/v1 ◽

2020 ◽

Author(s):

Hong Yang ◽

Jiabo Di ◽

Ming Cui ◽

Jiadi Xing ◽

Chenghai Zhang ◽

...

Keyword(s):

Rectal Cancer ◽

Neoadjuvant Chemoradiotherapy ◽

Disease Free Survival ◽

Radical Resection ◽

Low Rectal Cancer ◽

Oncologic Outcomes ◽

Cancer Specific Survival ◽

The Difference

Abstract Background: Neoadjuvant chemoradiotherapy (CRT) can downstage rectal carcinoma, resulting in superior resectability, better local control and survival benefits. However, it is unclear whether patients treated with CRT and those who did not have similar outcomes at the same pathological stage. This study aimed to investigate the long-term outcomes of ypT1-3N0 mid-low rectal cancer who received neoadjuvant CRT followed by total mesorectal excision (TME) compared with pT1-3N0 rectal cancer immediately managed with surgery. Methods: We retrospectively enrolled 180 patients with pT1-3N0 or ypT1-3N0 rectal cancer located within 10cm from the anal edge who underwent TME between 2009 and 2015. Of these patients, 63 received neoadjuvant CRT, while 117 underwent radical proctectomy without preoperative therapy. The disease-free survival (DFS) and cancer-specific survival (CSS) were compared between the two groups. Results: Within a median follow-up time of 65 months, the 5-year DFS was lower in the CRT group than the non-CRT group (74.9% vs. 92.6%, P=0.001), and the 5-year CSS presented a similar trend as well (89.6 % vs. 97.1%, P=0.054). By subgroup analysis, the difference in DFS and CSS was mainly caused by the difference between ypT3N0 and pT3N0 disease (71.1% vs. 96.1%, P＜0.001 and 90.9% vs. 100%, P=0.029, respectively). However, patients with ypT1-2N0 had an analogous prognosis to those with pT1-2N0 disease (77.9% vs. 89.0%, P=0.225 and 88.1% vs. 94.2%, P=0.292, respectively). Multivariate analysis indicated that neoadjuvant CRT was not an independent predictor of DFS. Conclusion: After neoadjuvant CRT followed by TME, patients with ypT1-2N0 rectal cancer had an analogous prognosis to those with initial pT1-2N0 disease, whereas patients with ypT3N0 rectal cancer had worse prognosis compared with that of pT3N0 disease.

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Nonsurgical Management of Rectal Cancer

Journal of Oncology Practice ◽

10.1200/jop.18.00769 ◽

2019 ◽

Vol 15 (3) ◽

pp. 123-131 ◽

Cited By ~ 4

Author(s):

Mehmet Akce ◽

Bassel F. El-Rayes

Keyword(s):

Rectal Cancer ◽

Neoadjuvant Therapy ◽

Surgical Resection ◽

Locally Advanced ◽

Pathologic Complete Response ◽

Rectal Adenocarcinoma ◽

Neoadjuvant Chemoradiotherapy ◽

Management Approach ◽

Nonsurgical Management ◽

Salvage Resection

Neoadjuvant chemoradiotherapy followed by surgical resection is the standard of care for locally advanced rectal adenocarcinoma. Up to one third of patients achieve pathologic complete response (CR) with neoadjuvant therapy. Promising disease-free and overall survival outcomes have been reported in patients who achieve clinical CR after neoadjuvant therapy without surgical resection. Furthermore, patients who have local recurrence have acceptable disease control outcomes with salvage resection. With consideration of morbidities associated with surgical resection and similar clinical outcomes, interest in nonsurgical management of low rectal cancers has emerged. Randomized clinical trials are being conducted to evaluate a nonsurgical approach in rectal cancer. Lack of consensus on the definition of clinical CR, molecular biomarkers, and standardized nonsurgical management protocols is a significant barrier for routine clinical implementation of a nonsurgical management approach. This article aims to provide a concise review of the clinical experience and practical approach to the nonsurgical management of locoregional rectal adenocarcinoma.

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Neoadjuvant treatment for rectal cancer in fit and vulnerable patients older than 70 years

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.13586 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 13586-13586

Author(s):

M. L. Friso ◽

L. M. Pasetto ◽

U. Basso ◽

S. Pucciarelli ◽

M. Rugge ◽

...

Keyword(s):

Rectal Cancer ◽

Elderly Patients ◽

Rating Scale ◽

Anal Verge ◽

Locally Advanced ◽

Neoadjuvant Treatment ◽

Rectal Adenocarcinoma ◽

Neoadjuvant Chemoradiotherapy ◽

Vulnerable Patients ◽

Lost To Follow Up

13586 Background: To evaluate the toxicity and feasibility of neoadjuvant 5FU continuous infusion or bolus in combination with pelvic radiotherapy (RT) in rectal cancer patients older than 70 years. Methods: From June 2000 to June 2005, 36 patients older than 70 years out of a total of 300 consecutive cases with histologically proven locally advanced rectal adenocarcinoma (≤ 12 cm from the anal verge) classified as either T3 or T4, N0 or N1–2 M0 disease, were examined. Comorbidities were evaluated according to Cumulative Illness Rating Scale-Geriatric (CIRS-G) and patients were deemed “fit” if they were otherwise healthy or had one or more comorbidities of only grade 1; “vulnerable” if had one or more comorbidities of grade 2. Results: Median age was 74 years (range, 70–82). 14 patients (5 healthy, 13.8%, and 9 with slight comorbidities, 25%) were fit and 22 (61.2%) were vulnerable. All the patients received the full course of RT, with a total dose of 50.4 Gy. The mean number of chemotherapy weeks was 5.34 (range, 2–6). 4 out 14 (28.6%) fit patients and 9 out 22 (40.9%) vulnerable patients had to interrupt chemotherapy prematurely because of toxicity (p=0.26). Vulnerable patients did not experience superior toxicity compared to fit patients (8/22 vulnerable and 6/14 fit patients developed toxicities of grade ≥ 2, p=0.69). With the exception of 2 fit and 2 vulnerable patients who were lost to follow up before surgery, 32 patients (88.9%) were operated. Thirty cases (12/14 fit patients, 85.7%, and 18/22 vulnerable patients, 81.8%) were radically resected without relevant postoperative complications. 13/20 vulnerable and 10/12 fit patients had a pathological downstaging of disease (p=0.24). Conclusions: Selected vulnerable elderly patients with rectal cancer can receive the same neoadjuvant chemoradiotherapy and undergo surgery as well as fit elderly patients since tolerability and response rate seem to be similar in both categories of patients. No significant financial relationships to disclose.

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