Preoperative combined radiotherapy and chemotherapy for middle and lower rectal cancer: Preliminary results

Background: Adjuvant treatment for rectal cancer is still controversial. Th is study reports on overall survival and disease-free survival, toxicity, d ownstaging, and surgical morbidity in rectal cancer patients who received c ombined chemoradiation therapy followed by curative surgery. Methods: Between 1993 and 1998, 51 patients (31 males and 20 females; media n age, 60 years; range, 33-73 years) underwent chemoradiation therapy follo wed by radical surgery for middle and lower rectal adenocarcinoma. Criteria for giving preoperative radiotherapy (rotal 45 Gy in 25 fractions of 1.8 G y/day for 5 weeks) and chemotherapy (5-fluorouracil 350 mg/m(2)/day and leu covorin 10 mg/m(2)/day, bolus on days 1-5 and 29-33) were an age younger th an 75 years; an Eastern Cooperative Oncology Group performance status score of 0 to 2; and clinical preoperative stage II-III. Forty-three low anterio r and eight abdominoperineal resections were pet-formed. Median follow-up t ime was 29 (range, 3-63) months. Results: Although grade 3 to 4 toxicity occurred in 14 cases (27.4%), all p atients completed the planned adjuvant therapy. At pathology, a complete re sponse was found in eight (15.7%) cases. Of the remaining 43 cases, 22 were stage I, 12 were stage II, and 9 were stags III. Five-year actuarial disea se-free survival and overall survival rates were 86.4% and 85.5%, respectiv ely. Whereas no local recurrences were found, 4 patients had distant metast ases, Three patients died (1 of cancer-related causes), 45 are alive and di sease free, and 3 are alive with disease. Conclusions: The combined preoperative chemoradiation approach used by us s eems to improve the disease-free survival and overall survival of selected patients with rectal cancer. However, a longer follow-up time is required t o confirm these preliminary results.