Neoadjuvant Chemotherapy Rather than Neoadjuvant Chemoradiotherapy in Patients with Locally Advanced Rectal Cancer with High Tumor Burden

Background/Aims: We investigated the characteristics of locally advanced rectal cancer (LARC) patients who had received neoadjuvant chemoradiotherapy (NCRT), and who developed early metastasis during the perioperative period. Methodology: LARC who were treated and followed-up were included in this study. Patients' files were reviewed retrospectively and the data on patients were recorded. Results: Totally, 182 stage II and III rectal cancer patients who received NCRT were retrospectively evaluated. Seventeen (9.3%) patients were metastatic during the perioperative period. Of them, metastases developed pre-operatively in 3 (17.6%) patients after NCRT, while 14 (82.4%) developed metastases postoperatively before adjuvant chemotherapy (CT). Twelve (70.6%) patients had clinical stage T4N+ disease. The median time interval between pathological diagnosis and metastasis development was 4 (3-5) months. The median survival was 24 months. Conclusions: More effective treatment is warranted in patients with LARC with a high tumor burden.