Abstract

PURPOSE
To assess the tumor response, sphincter preservation, acute toxicity and survival with preoperative concurrent chemoradiation in locally advanced rectal cancer.
MATERIALS AND METHODS
Fifty-four patients were treated with preoperative chemoradiaton for tumor downstaging and sphincter preservation. Radiation was delivered to whole pelvis to 45 Gy followed by a boost 5.4 Gy to primary tumor site. Chemotherapy consists of concurrent 2 cycles of 5-fluorouracil (500 mg/m2/day) and leucovorin (20 mg/m2/day). Surgery was performed approximately 6 weeks after treatment.
RESULTS
Median follow-up period and rate were 48 months and 98%, respectively. The downstaging including primary tumor and lymph node occurred in 64%. Three of 53 patients (6%) had pathologic complete response. The resectability of tumor was 98%. A sphincter preservation was possible in 61%. Three patients developed grade 4 hematologic toxicity. Grade 3 skin erythema and diarrhea were 24% and 18%, respectively. The 5-year survival and local disease-free survival were 62% and 89%, respectively. Local failure and distant metastasis rate were 9% and 35%, respectively.
CONCLUSION
Preoperative chemoradiation affords considerable downstaging with acceptable acute toxicity and postoperative morbidity. Also sphincter preservation is feasible by improved downstaging of tumor. This treatment could be improved local control of tumor, and may have a potential for long-term survival.

• Keywords: Rectal neoplasm;Preoperative chemoradiation;Sphincter preservation