Distant Metastasis Identified Immediately after Preoperative Chemoradiotherapy for Locally Advanced Rectal Cancer

ABSTRACT

PURPOSE: This study was designed to analyze the clinical characteristics of patients with immediate distant metastasis after preoperative chemoradiotherapy for locally advanced rectal cancer and to help select patients for preoperative chemoradiotherapy. METHODS: Two hundred eight patients, who underwent preoperative chemoradiotherapy for locally advanced rectal cancer, were included. Patients were excluded from the study if they had tumor types other than an adenocarcinoma, prior chemotherapy, radiotherapy, or hereditary nonpolyposis colorectal cancer. The clinicopathological characteristics of patients with distant metastasis immediately after preoperative chemoradioterapy were compared with those of patients without distant metastasis. RESULTS: Distant metastases immediately after preoperative chemoradiotherapy were identified in 15 patients (7.2%). The liver was the most common site of metastasis (8/15), followed by peritoneal seeding (4), the lung (2), bone (1), and the aortocaval lymph node (1). Age, sex, chemotherapy regimen used, and primary tumor response for patients with distant metastases were similar to those for patients without distant metastasis. In patients with immediate distant metastasis, pre-chemoradiotherapy CEA was significantly higher (11.1 vs. 7.4 ng/ml; P= 0.003). CONCLUSIONS: Immediate distant metastasis after preoperative chemoradiotherapy is associated with pre-chemoradiotherapy CEA level. A careful work-up is necessary when pre-chemoradiotherapy CEA is higher than the normal range.