Long-term Result for Rectal Cancer in Cases of a Curative Resection after Preoperative Chemoradiotherapy

ABSTRACT

PURPOSE: Preoperative chemoradiation is the recommended standard therapy for locally advanced rectal cancer and is associated with sphincter preservation and improved survival. Our study was performed to determine the surgical outcomes and the prognostic factors for rectal cancer with preoperative chemoradiotherapy (PCRT) followed by a relative curative resection. METHODS: We retrospectively reviewed the cases of 251 advanced rectal cancer patients who underwent a PCRT, between Jan 1995 and Dec 2002. All patients a received 25 days RTX (total dose 4,500~5,040 cGy) and intravenous 5-FU (425 mg/m2/ day) plus leucovorin (20 mg/day) for 24 hrs. Surgery was performed about 4~6 weeks after completion of RTX. The median follow up was 79 months (range 1-142). RESULTS: All patients were comfortable with PCRT. Postoperative mortality was 1.1%. After PCRT, 92.2% of the patients and, especially, 82.2% of the low rectal cancer patients had sphincter preserving surgery. Complete remission of the tumor was stenin 15.1% of the cases, but was not significantly associated with recurrence. The overall recurrence and the local recurrence rates were 15.1% and 4.4%, respectively. Cell differentiation, circumferential margin, and lymphovascular invasion were independent risk factors for local recurrence in the multivariate analysis. Prognostic factors for overall and disease-free survival were cell differentiation, circumferential margin, lymphovascular invasion, and lymph node metastasis in the multivariate analysis. The 5-year disease-free survival rates for stages I, II, and III, and for no-residual tumor were 96.1%, 83.4%, 69.0%, and 89.1%, respectively (P<0.05). CONCLUSIONS: Advanced rectal cancer treated using preoperative chemoradiation resulted in excellent sphincter preservation. Our long-term follow-up results showed good local control and improved survival for rectal cancer.