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Preoperative Chemoradiation in Patients With Resectable Rectal Cancer: Results on Tumor Response

From the Departments of Surgical Oncology I (FB, DB), Pathology (SA), Medical Oncology A (SCS), Radiotherapy (FV), and Endoscopic Surgery (PS) and the Division of Medical Statistics and Biometry (LM), Istituto Nazionale per lo Studio e la Cura dei Tumori (National Cancer Institute), Milan, Italy.

Correspondence: Address correspondence and reprint requests to: Federico Bozzetti, MD, Istituto Nazionale per lo Studio e la Cura dei Tumori, Via Venezian, 1 20133 Milan, Italy; Fax: 39-02-23903259; E-mail: dottfb{at}tin.it

Background: There is no consensus about the role of preoperative radiotherapy (RT) and chemotherapy (CT) in patients with resectable cancer of the distal rectum. This study analyzed the local clinical and pathologic response in patients receiving preoperative RT/CT for rectal cancer.

Methods: Thirty-two consecutive patients with a palpable adenocarcinoma of the rectum received preoperative RT (45 Gy in 25 fractions over 5 weeks) plus continuous chemotherapy with doxifluridine and leucovorin or 5-fluorouracil by continuous intravenous infusion during RT. Surgery was performed 8 weeks later. The Wilcoxon and ² tests were used for data analysis.

Results: Twelve patients had mild gastrointestinal toxicity, only one of whom required interruption of therapy. The tumor shrank to 57.8% of its original size, and at the echoendoscopy (u) there was a 58.7% decrease of the maximum diameter (P < .001). Downstaging from uT3 and uT2 to <uT3 and <uT2, respectively, occurred in 41.6% of patients (P = .0020). Total and major regression of the tumor at the histopathologic examination occurred in 12.5% and 50% of patients.

Conclusions: Local response to preoperative RT/CT was highly satisfactory and allowed conservative surgery in 81% of patients. Optimization of the combined therapy could achieve even better results.

Key Words: Rectal cancer • Neoadjuvant therapy • Preoperative chemoradiation • Preoperative radiotherapy

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