Pre-operative radiochemotherapy of locally advanced rectal cancer

AIM:To evaluate results of pre-operative radiochemotherapyfollowed by surgery for 25 patients with locally advancedun-resectable rectal cancer.METHODS:15 patients with advanced non-resectable rectalcancer were treated with pre-operative irriadiation of 40-46 Gy plus concomitant chemotherapy(5-FU+LV and 5’-DFuR)(RCS group).For comparison,27 similar patients,treated by preoperative radiotherapy(40-50 Gy)plus surgerywere served as control(RS group).RESULTS:No radiochemotherapy or radiotherapy wasinterrupted and then was delayed because of toxicities inboth groups.The radical resectability rate was 73.3%inthe RCS group and 37.0 %(P=0.024)in RS group.Sphincterpreservation rates were 26.6%and 3.7%respectively(P=0.028).Sphincter preservation rates of lower rectal cancerwere 27.3%and 0.0%respectively(P=0.014).Responserates of RCS and RS groups were 46.7%and 18.5 %(P=0.053).The tumor downstage rates were 8(53.3 %)and 9(33.3 %)in these groups(P=0.206).The 3-year overallsurvival rates were 66.7%and 55.6 %(P=0.485),and thedisease free survival rates were 40.1%and 33.2 %(P=0.663).The 3-year local recurrent rates were 26.7 %and 48.1%(P=0.174).No obvious late effects were foundin either groups.CONCLUSION:High resectability is possible following pre-operative radiochemotherapy and can have more sphincterspreserved.It is important to improve the quality of thepatients’life even without increasing the survival or localcontrol rates.Preoperative radiotherapy with concomitantfull course chemotherapy(5-Fu+LV and 5’-DFuR)is effectiveand safe.