Preoperative Chemoradiotherapy and Total Mesorectal Excision Surgery for Locally Advanced Rectal Cancer: Correlation With Rectal Cancer Regression Grade
| Autor: | E. Dodds, J. M. D. Wheeler, Bruce George, A. C. Jones, Bryan F. Warren, N. J. McC. Mortensen, Chris Cunningham |
|---|---|
| Rok vydání: | 2004 |
| Předmět: |
Adult
Male Antimetabolites Antineoplastic medicine.medical_specialty Colorectal cancer Colonic Pouches Colonoscopy Rectum Adenocarcinoma Preoperative care Colostomy Preoperative Care medicine Carcinoma Humans Aged Neoplasm Staging Proportional Hazards Models Aged 80 and over medicine.diagnostic_test Rectal Neoplasms business.industry Gastroenterology Radiotherapy Dosage General Medicine Middle Aged medicine.disease Survival Analysis Total mesorectal excision Colorectal surgery Surgery Treatment Outcome medicine.anatomical_structure England Chemotherapy Adjuvant Female Radiotherapy Adjuvant Fluorouracil Neoplasm Recurrence Local business Chemoradiotherapy Follow-Up Studies |
| Zdroj: | Diseases of the Colon & Rectum. 47:2025-2031 |
| ISSN: | 0012-3706 |
| DOI: | 10.1007/s10350-004-0713-x |
| Popis: | PURPOSE: Preoperative long-course chemoradiotherapy is recommended for rectal carcinoma when there is concern that surgery alone may not be curative. Downstaging of the tumor can be measured as rectal cancer regression grade (1-3) and may be of importance when estimating the prognosis. The aim of this study was to look at the long-term results of tumor regression in patients receiving long-course chemotherapy before surgical resection of rectal cancer. METHODS: We reviewed those patients who received preoperative chemoradiotherapy followed by surgical resection for carcinoma of the mid rectum or distal rectum found to be stage T3/4 between January 1995 and November 1999. Patients received 45 to 50 Gy irradiation in 2-Gy fractions and an infusion of 5-fluorouracil. Surgical specimens were assessed for rectal cancer regression grade. Patients were followed up routinely with clinical examination, computed tomography, and colonoscopy. RESULTS: Sixty-five patients with a mean age 65 (range, 32-83) years underwent chemoradiotherapy before surgical resection. Thirty patients (46 percent) were classified as rectal cancer regression Grade 1, with 9 patients (14 percent) having complete sterilization of the tumor. Fifty-three patients (82 percent) underwent a curative resection. Overall survival, with a median follow-up of 39 (range, 24-83) months, was 67 percent and was associated with tumor downstaging. The local recurrence rate was 5.8 percent in those patients who underwent a curative resection and was significantly lower with rectal cancer regression Grade 1 tumors (P = 0.03). Eight of nine patients (89 percent) whose tumor had been sterilized were alive and well with no recurrence of tumor at a median follow-up of 41 (range, 24-70) months. CONCLUSIONS: Preoperative chemoradiotherapy resulted in significant regression of tumor. Overall survival was high and was associated with downstaging of tumor. The local recurrence rate was significantly lower with rectal cancer regression Grade 1 tumors and was not seen in patients with sterilized tumors. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full text from SpringerLink