The importance of delay in tumor patients exemplified by the pretreatment of locally advanced rectal cancer

Background: With the intention to achieve turner reduction and thereby incr ease RO-resection rate, preoperative radiochemotherapy is increasingly appl ied in locally advanced rectum cancer. Along with the advantages of Drier t herapy, a delay of surgical treatment occurs which might despite continuing therapy give way to local tumor progression or metastatic disease. Patients and Methods: Since 1993 we have treated locally advanced rectum ca rcinomas by preoperative radiotherapy according to a preoperative study pro tocol. We analyzed the incidence of local tumor progression or metastases d uring the 12 weeks of preoperative treatment. Hundred and fifteen patients with histologically proven primary rectum carcinoma without evidence of reg ional or distant metastases and endosonographically determined infiltration depth of stage T3 or more underwent preoperative radiochemotherapy between 3/1993 and 10/1999. Hundred and eight patients (88 times uT3 and (20 times uT4) have been operated and examined afterwards with respect to response t o Drier treatment. Before and after preoperative therapy, endorectal ultras ound was performed to evaluate local response. Distant metastatic manifesta tions were excluded by radiography and ultrasound scanning. Results: A reduction of the infiltration depth was observed in 55 patients (51%). Tumor size remained unchanged in 50 patients (46%). Only 3 patients (3%) showed tumor growth in histological assessment. Fifty-seven patients ( 53%) showed no change in lymphonodal status after preoperative therapy, whe reas lymphonode metastases were detected in 11 patients (10%) who were judg ed uN0 preoperatively. We discovered metastases in 6 patients (6%) after pr eoperative therapy. Conclusion: During preoperative therapy, tumor progress is not entirely evi table. Considering the lack of precision in pretherapeutic staging diagnost ics, we conclude that delays due to therapeutic regimen are responsible for prognostic disadvantage in only a small number of patients.