Preliminary clinical observation of neoadjuvant chemoradiotherapy for low and locally advanced rectal cancer
Liu Lu1, Feng Linchun1, Liu Qiteng2, Jia Baoqing3, Du Xiaohui3, Dai Guanghai4, Chen Jing1, Dai Xiangkun1, Yang Tao1
1Department of Radiation Oncology, the Fifth Medical Center, Chinese PLA General Hospital, Medical School of Chinese PLA;Beijing 100853, China; 2Department of Radiation Oncology, Beijing Luhe Hospital, Capital Medical University, Beijing 101149, China; 3Department of General Surgery, the First Medical Center, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing 100853, China; 4Department of Medical Oncology,the Fifth Medical Center, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing 100853, China
Abstract：Objective To evaluate the efficacy of preoperative neoadjuvant chemoradiotherapy for low and locally advanced rectal cancer. Methods Clinical data of 46 patients with low rectal tumors located within 6 cm from the edge of anal admitted to our hospital between February 2014 and December 2018 were retrospectively analyzed. SIB-IMRT technique was adopted for preoperative radiotherapy. Rectal tumors and positive lymph nodes were irradiated with a dose of 58.75 Gy in 25 fractions (2.35 Gy/fraction), and pelvic lymphatic drainage area was given with 50 Gy in 25 fractions (2.0 Gy/fraction). Oral administration of capecitabine was delivered for concurrent chemotherapy. Radical surgery for rectal cancer was performed at 6 to 12 weeks after the end of chemoradiotherapy. The overall survival (OS), disease-free survival (DFS), progression-free survival (PFS), local recurrence-free survival (LRFS) and metastasis-free survival (MFS) were calculated by using Kaplan-Meier method. Univariate analysis was conducted by log-rank test, and multivariate analysis was performed by Cox’s regression model. Results After a median follow-up of 47 months, local recurrence occurred in 3 patients and distant metastasis in 6 patients. The ypCR rate was 26%(12/46), the sphincter-preservation rate was 74%(34/46), the R0 resection rate was 100%(44/44), the overall tumor response TN down staging rate was 87%(40/46), and the postoperative complication rate was 13%(6/46). The 3-year OS, DFS, and PFS were 93%,91% and 87%, respectively. In univariate analysis, ypN staging was an important factor affecting OS, DFS, PFS, LRFS and MFS (all P<0.05). In multivariate analysis, ypN staging was significantly correlated with DFS, PFS, LRFS and MFS (all P<0.05). Conclusions Preoperative SIB-IMRT 58.75 Gy in 25 fractions combined with capecitabine chemotherapy is a safe and efficacious treatment for patients with low and locally advanced rectal cancer, which improves the ypCR rate and quality of life, and yields tolerable adverse reactions. Nevertheless, the long-term survival benefits remain to be validated.
Liu Lu,Feng Linchun,Liu Qiteng et al. Preliminary clinical observation of neoadjuvant chemoradiotherapy for low and locally advanced rectal cancer[J]. Chinese Journal of Radiation Oncology, 2020, 29(11): 954-958.
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