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Annals of Surgical Oncology 9:568-573 (2002)
© 2002 Society of Surgical Oncology

ORIGINAL ARTICLES

Chemoradiation Instead of Surgery To Treat Mid and Low Rectal Tumors: Is It Safe?

Wilson T. Nakagawa, MD, Benedito M. Rossi, MD, PhD, FACS, CSSO, Fábio de O. Ferreira, MD, PhD, Robson Ferrigno, MD, Waldec J. David Filho, MD, Inês N. Nishimoto, MSc, Rene A. C. Vieira, MD and Ademar Lopes, MD, PhD, FACS, FSSO

From the Pelvic Surgery Department, A. C. Camargo Cancer Hospital, Antonio Prudente Foundation, São Paulo, Brazil.

Correspondence: Address correspondence and reprint requests to: Wilson T. Nakagawa, MD, Departamento de Cirurgia Pélvica, Hospital do Câncer A. C. Camargo, Rua Prof. Antonio Prudente, 211, 01509-010, São Paulo, Brazil; Fax: 55-11-3272-5100; E-mail: wtnakagawa{at}uol.com.br

Background: The main treatment for rectal carcinoma is surgery. Preoperative chemoradiation (CRT) is advocated to reduce local recurrence and improve resection of mid and low tethered rectal tumors.

Methods: Fifty-two patients with mid or low rectal tumors underwent CRT (external beam radiation plus 5-fluorouracil plus folinic acid). Patients who had low rectal tumors with complete response (CR) were not submitted to surgical treatment. All other patients were submitted to surgery, independently of the response. Mean follow-up was 32.1 months.

Results: Five-year overall survival was 60.5%. Clinical evaluation after CRT showed CR in 10 cases (19.2%), all low tumors; incomplete response (>50%) in 21 (40.4%); and no response (<50%) in 19 (36.6%). Among the 10 cases with CR, 8 presented with local recurrence within 3.7 to 8.8 months. Two patients were not submitted to surgery and are still alive without cancer after 37 and 58 months. Thirty-nine patients had radical surgery. Seven had local recurrences after CRT plus surgery (17.9%). Overall survival was negatively affected by lymph node metastases (P = .017) and perineural invasion (P = .026).

Conclusions: Exclusive CRT approach is not safe to treat patients with low infiltrative rectal carcinoma.

Key Words: Rectal adenocarcinoma • Rectal cancer • Chemotherapy • Radiotherapy • Surgery




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