Publication: Clinical outcome of neoadjuvant chemoradiation in rectal cancer treatment
3
Issued Date
2021-09-24
Resource Type
ISSN
15365964
00257974
00257974
Other identifier(s)
2-s2.0-85117538189
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Mahidol University
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SCOPUS
Bibliographic Citation
Medicine (United States). Vol.100, No.38 (2021)
Suggested Citation
Weerapat Suwanthanma, Saowanee Kitudomrat, Chakrapan Euanorasetr Clinical outcome of neoadjuvant chemoradiation in rectal cancer treatment. Medicine (United States). Vol.100, No.38 (2021). doi:10.1097/MD.0000000000027366 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/77844
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Title
Clinical outcome of neoadjuvant chemoradiation in rectal cancer treatment
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Abstract
To determine the clinical and pathological outcome of locally advanced rectal cancer patients treated with neoadjuvant chemoradiation (chemoradiotherapy [CRT]) followed by curative surgery and to identify predictive factors of pathological complete response (pCR). Locally advanced rectal cancer patients undergoing CRT followed by curative surgery from January 2012 to December 2017 were included. Patient s demographic data, pretreatment tumor characteristics, type of CRT regimens, type of surgery, postoperative complications, pathological reports and follow up records were analyzed. Univariate and multivariate analyses were applied to identify predictive factors for pCR. Five-year disease free and overall survival were estimated by Kaplan Meier method and compared between pCR and non-pCR groups. A total of 85 patients were analyzed. Eighteen patients (21.1%) achieved pCR. The sphincter-saving surgery rate was 57.6%. After univariate analyses, tumor length 4cm(P=.007) and positive lymph nodes (P=.040) were significantly associated with decreased rate of pCR. Complete clinical response was significantly associated with higher rate of pCR (P=.015). Multivariate analyses demonstrated that tumor length 4cm(P=.010) was significantly associated with decreased rate of pCR. After a median follow-up of 65months (IQR 34 79), the calculated 5-year overall survival and disease-free survival rates were 81.4% and 69.7%, respectively. Patients who achieved pCR tend to had longer 5-year disease-free survival (P=.355) and overall survival (P=.361) than those who did not. Tumor length 4cm was associated with decreased rate of pCR in locally advanced rectal cancer who had CRT followed by surgery. Longer waiting time or more intense adjuvant treatment may be considered to improved pCR and oncological outcomes. Abbreviations: 3D-CRT = three-dimension conformal radiotherapy, 5-FU = 5-fluorouracil, APR = abdominoperineal resection, cCR = clinical complete response, CEA = carcinoembryonic antigen, CI = confidence interval, CRT = chemoradiotherapy, CT = computerized tomography, DFS = disease free survival, Gy = Gray, IQR = interquartile range, LAR = low anterior resection, LV = leucovorin, MRI = magnetic resonance imaging, N downstaging = node downstaging, OR = odds ratio, OS = overall survival, pCR = pathological complete response, T downstaging = tumor downstaging, TME = total mesorectal excision, UltraLAR = ultra low anterior resection, XELOX = Xeloda+Oxaliplatin chemotherapy regimen, ypT = pathological tumor stage after neoadjuvant chemoradiation.