Prognostic significance of postchemoradiation stage following preoperativechemotherapy and radiation for advanced/recurrent rectal cancers

Purpose: To evaluate the prognostic significance of postchemoradiation path ologic stage and implications for further therapy following preoperative ch emoradiation and surgery for advanced/recurrent rectal cancer, Methods and Materials: Seventy-seven patients with advanced (fixed or tethe red T4) or recurrent rectal cancer were treated with preoperative chemorada tion followed by surgical resection of disease. Chemotherapy consisted of e ither of bolus 5-FU 500 mg/m(2) per day or continuous venous infusion 225 m g/m2 per day for the duration of radiation, Radiation therapy was planned t o be delivered to the whole pelvis to a dose of 35 Gy followed by a boost t o the area of the tumor of 5-15 Gy, Total radiation doses ranged from 40 to 63 Gy with a median of 55.8 Gy, Surgical resection was then carried out 6- 10 weeks following the completion of treatment (median, 7 weeks). Twenty-ei ght patients underwent abdominoperineal resection and and 49 patients had s phincter-sparing surgical procedures. None of the patients received postope rative chemotherapy, Follow-up in these patients ranges from 1 year to 8 ye ars with a median of 3 years. Results: Significant downstaging of disease was observed with 12/77 (16%) h aving no residual disease(pTO) and 13% (10/77) found to have pT1-2, N0 dise ase, 31% (24/77) with pT3-4, N0 and 40% (31/77) for pT0-4, N1-2 cancers. Su rvival by pathologic stage was 100% for pT0-2, NO cancers, 80% for pT3-4, N 0 and 73% for pTx, N1-2, Local recurrence of disease was observed in 0% of patients with pT0-2, NO as compared with 13% (3/24) in pT3-4, NO and 16% (5 /31) in pT0-4, N1-2 patients. Conclusion: Downstaging following preoperative chemoradiation is a signific ant prognostic factor, Patients with pT0, T1, or T2 disease have an excelle nt prognosis and are unlikely to fail locally or with systemic disease. How ever, patient with T3/T4 or N+ disease may benefit from further adjuvant ch emotherapy. (C) 2000 Elsevier Science Inc.