Preoperative Chemoradiotherapy in Locally Advanced Rectal Cancer: Ramathibodi Experience
Ekaphop Sirachainan, MD*, Kanit Sumboonnanonda, MD**, Somjai Dangprasert, MD***, Ravat Panvichian, MD*, Thitiya Sirisinha, MD*, Mantana Dhanachai, MD***, Virat Pairachvet, MD***, Puangtong Kraiphibul, MD***, Vorachai Ratanatharathorn, MD*
Affiliation : * Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University ** Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University *** Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University
A retrospective study of the preoperative chemoradiotherapy in locally advanced rectal cancer performed at Ramathibodi Hospital. The median age of twelve patients was 52 years. The tumor locations (upper-, mid-, lower rectum) were 25%, 50% and 25%, respectively. Eleven patients had clinical stage III disease. All received concurrent 5-FU-based chemoradiotherapy followed by surgery (if resectable) and chemotherapy. The most common toxicity of preoperative treatment was gr.1-2 diarrhea (58.3%). The response rate was 41.7%. Five patients (41.7%) underwent sphincter-sparing surgery. Four patients underwent AP resection. Twenty-five percent achieved pathological complete response. Pathological downstaging occurred in 33.3%. The remaining three patients had unresectable disease. With the median follow up of 13 months, five patients had progressive disease and one has expired. The local failure rate was 16.7%. The one-year recurrence-free survival was 75%. The authors conclude that preoperative chemoradiotherapy is an effective treatment with favorable outcome in locally advanced rectal cancer.
Keywords : Preoperative chemoradiotherapy, Locally advanced rectal cancer, Sphincter-sparing surgery
