A team from Durham, North Carolina, USA, examined clinical outcomes in patients receiving neoadjuvant chemoradiation for locally advanced rectal adenocarcinoma.
A retrospective chart review was performed on 141 consecutive patients who received neoadjuvant chemoradiation (5-fluorouracil with or without cisplatin and 4,500-5,040 cGy) for biopsy-proven locally advanced adenocarcinoma of the rectum.
Surgery was performed 4 to 8 weeks after completion of chemoradiation. Standard statistical methods were used to analyze recurrence and survival.
|Positive lymph node status predicts increased local recurrence of rectal cancer.
|Annals of Surgery|
Median follow-up was 27 months, and mean age was 59 years. The mean tumor distance from the anal verge was 6 cm.
Of those staged before surgery, with endorectal ultrasound or magnetic resonance imaging, 57% of Stage II patients, and 82% of Stage III patients were downstaged.
The chemotherapeutic regimens were well tolerated, and resections were performed on 140 patients.
It was found that the percentage of sphincter-sparing procedures increased from 20% before 1996, to 76% after 1996.
On pathologic analysis, 24% of specimens were Stage T0. However, postoperative pathologic T stage had no effect on either recurrence or survival.
Positive lymph node status predicted increased local recurrence and decreased survival.
Dr Mark W. Onaitis, of the Duke University Medical Center, concluded on behalf of the group, "Neoadjuvant chemoradiation is safe, effective, and well tolerated.
"Postoperative lymph node status is the only independent predictor of recurrence and survival."