統合腫瘍学ジャーナル

Impact of Preoperative Chemo-radiation Therapy on Systemic Failure in Locally Advanced Rectal Cancer

Abstract

Mahdi Hussain Al Bandar, Yoon Dae Han, Min Soo Cho, Hyuk Hur, Byung Soh Min, Kang Young Lee and Nam Kyu Kim

Background and objectives: Advanced rectal cancers require local and systemic control. Chemo radiotherapy (CRT) is adequate to achieve adequate local control. Systemic control, however, is a dominant obstacle remained in debates. We compared oncology outcome in both arms in patients with advanced rectal cancers in order to identify high-risk group of distant metastasis. Methods: Data for 723 patients for advanced rectal cancer from 2005 to 2013 retrieved retrospectively. Patients were classified to CRT (n=364) or no CRT (n=359) arms. Results: CRT group showed greater local control and achieved pT stage 0, 1, or 2 in 43.7% vs. 28.4% in no CRT (p<0.001) and less CEA marker (11.17 ± 25.2 vs. 6.14 ± 11.3, p<0.001), respectively. Although CRT group had higher rates of advanced tumors, cT3 or T4 (341(93.7%) vs. 294(81.9%), p<0.001) and CRM threat (167 (45.9%) vs. 30(8.4%); p<0.001). Overall local recurrence rate observed in no CRT 3% compared to 2.1% in CRT arm, (p<0.005). Systemic recurrence rate was similar in both groups, (22.5% vs. 23%), respectively. Conclusion: CRT is efficient to downstage locally advanced rectal cancer, not systemic control though. Early recognition of high-risk group is recommended in order to consider CRT modification ahead of planned surgery.