NEOADJUVANT INTRAARTERIAL POLYCHEMOTHERAPY OF LOCALLY ADVANCED RECTAL-CANCER

In order to evaluate the usefulness of pre-operative intra-arterial se lective polychemotherapy (PIASP), we carried out a retrospective study of 107 patients (65 males, 42 females) with locally advanced rectal c ancer (LARC) (pT3-4 N0-1 M0), who were treated between 1988 and 1991. Fifty-two patients (MG) underwent PIASP (Adriablastin 60-90 mg, fluoro uracil 3-4 g) with subsequent radical surgery. Fifty-five patients (R0 ) received surgery alone. Angiographic findings after PIASP showed sim ilar to 50-70% reduction in the vascular network in the tumour and sur rounding tissues. A post-operative morphological study confirmed the c onsiderable tumour dystrophy, necrobiosis and necrosis. Comparative st atistical analysis in two patient groups showed that overall 5-year su rvival was significantly better in MG (64.76+/-1.85%) than in R0 (38.2 3+/-1.74%; chi(2)=9.1; P<0.05). A similar situation was observed in al l research subgroups: T3 N0 M0 (MG, 85.71+/-3.29% and R0, 65.63+/-2.85 %; chi(2)=2.61; P<0.05); T3 N1 M0 (MG, 47.06+/-4.68% and R0, 0.0, X-2= 14.37; P<0.05); T4 N0-1 M0 (MG, 8.57+/-4.29% and R0, 0.0, chi(2) =2.0 9; P<0.05). Significantly better 5-year survival rates were seen in MG than in R0 with the medial cellular differentiation in carcinoma (77. 42+/-2.98% and 36.23+/-2.41%, chi(2)=9.81; P<0.05, respectively), the most frequent histological tumour structures. There is a trend for imp roved 5-year survival in low differentiation carcinoma (MG, 47.62 + 5. 29% and R0, 35.29+/-4.37%, chi(2) = 0.28, P>0.05). The MG group showed eight local relapses of disease (15.38%), while the R0 group showed 2 1 (38.1%), the MG group demonstrated 12 distant metastasis (23.07%) wh ile R0 demonstrated 19 (34.54%), the median relapse-free survival was 101.6 weeks in MG and 74.45 weeks in R0. The use of the combined PIASP with subsequent surgery treatment of patients with LARC allows a bett er prognosis than does surgery alone.