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. 2010 May 20;15(3):51-9.
doi: 10.1016/j.rpor.2010.04.002. eCollection 2010.

Impact of neoadjuvant chemoradiation on pathologic response and survival of patients with locally advanced rectal cancer

Sofia Conde  1 , Margarida Borrego  1 , Tânia Teixeira  1 , Rubina Teixeira  1 , Maria Corbal  1 , Anabela Sá  2 , Paula Soares  1
Affiliations

Impact of neoadjuvant chemoradiation on pathologic response and survival of patients with locally advanced rectal cancer

Sofia Conde et al. Rep Pract Oncol Radiother. .

Abstract

Background: The impact of neoadjuvant chemotherapy (CT) and radiotherapy (RT) on overall survival (OS) has been controversial. Some studies have pointed to an improvement in OS and disease-free survival (DFS) in patients with pathologic complete response (pCR).

Aim: To evaluate the therapeutic response and impact on survival of preoperative RT, alone or combined with CT, in patients with locally advanced rectal cancer (LARC).

Materials and methods: A set of 132 patients with LARC were treated preoperatively. GROUP 1: RT alone, 19 patients. GROUP 2: RT and concomitant oral CT (Capecitabine or UFT + leucovorin), 68 patients. GROUP 3: RT and concomitant CT with 5-FU in continuous infusion, 45 patients. 58.2% of patients were submitted to adjuvant CT.

Results: GROUP 1: no pCR, tumoral downstaging was 26.7%. GROUP 2: pCR in 16.9%; tumoral downstaging was 47.7%. GROUP 3: pCR in 11.9%; tumor downstaging was 52.4%. The loco-regional control (LRC) was 95%. The 5-year OS (p = 0.038) and DFS (p = 0.05) were significantly superior in patients treated with CT + RT. Patients with pCR had a significant increase on DFS (p = 0.019). Patients cT3-4 that had a tumoral downstaging to ypT0-2, showed an increase on DFS, OS and LRC.

Conclusions: CT combined with RT has increased tumoral response and survival rate. Nodal downstaging and pCR were higher in the GROUP 2. The 5-year OS and DFS were significantly superior in CT + RT arms. Patients with pathologic response showed a better DFS. Adjuvant CT had no impact on LRC, DFS nor on OS.

Keywords: Adjuvant chemotherapy; Neoadjuvant chemoradiotherapy; Pathologic complete response; Rectal cancer.

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Figures

Fig. 1
Fig. 1
Tumor downstaging.
Fig. 2
Fig. 2
Nodal downstaging.
Fig. 3
Fig. 3
Loco-regional response to neoadjuvant therapy.
Fig. 4
Fig. 4
Pathologic complete response rate.
Figs. 5 and 6
Figs. 5 and 6
OS and DFS of patients treated with neoadjuvant RT vs. neoadjuvant CT + RT.
Figs. 7 and 8
Figs. 7 and 8
pCR impact on OS and DFS.
Figs. 9–11
Figs. 9–11
Impact of pathologic downstaging to ypT0–2 on LRC, DFS and OS.
Fig. 12
Fig. 12
Impact of adjuvant CT on DFS in patients submitted to neoadjuvant CT + RT.
See this image and copyright information in PMC

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