Liu XM, Ayiguli•Hare, Zaiyinuer•Abuduwaili, Zhang JR, Yisikandaer•Abulimiti. Efficacy of different treatment strategies for stage Ⅱ-Ⅲ rectal cancer.
Shijie Huaren Xiaohua Zazhi 2015;
23:3706-3713. [DOI:
10.11569/wcjd.v23.i23.3706]
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Abstract
AIM: To compare the efficacy of four treatment strategies for stage Ⅱ-Ⅲ rectal cancer and analyze prognostic factors.
METHODS: A retrospective study was conducted on 230 patients who were pathologically diagnosed with stage Ⅱ-Ⅲ rectal cancer and underwent pelvic intensity modulated radiotherapy and concurrent fluorouracil based chemotherapy between January 2010 and December 2013 at Affiliated Tumor Hospital of Xinjiang Medical University, including 68 cases receiving neoadjuvant chemoradiotherapy combined with surgery (group A), 70 cases receiving postoperative chemoradiation (group B), 51 cases receiving neoadjuvant chemoradiotherapy without surgery (group C), and 41 cases receiving radical chemoradiation (group D). (Neo-) adjuvant radiotherapy was delivered at 50 Gy in 25 fractions, and radical radiotherapy was delivered at 60-66 Gy in 30-33 fractions. Surgical patients were treated by total mesorectal excision. Time interval between radiotherapy and surgery was 4-8 wk.
RESULTS: The follow-up rate was 93.4%, and 144 patients completed the 3-year follow-up. Local recurrence in 3 years was noted in 53 cases, and 44 cases had distant metastasis in the four groups; both the 3-year recurrence rate and distant metastasis rate had no statistical significance among different groups. The 3-year overall survival (OS) and disease-free survival (DFS) rates were statistically different (P = 0.001, 0.004). The rates of OS (86.76%) and DFS (76.27%) in group A were significantly higher than those in the other groups. Complete (R0) tumor resectability was 98.5% in group A and 78.5% in group B. Main toxicities were grade 1-2 adverse events. Multivariate analysis demonstrated that neoadjuvant chemoradiotherapy without surgery (P = 0.002), age (P = 0.021) and circumferential tumor (P = 0.029) were prognostic factors.
CONCLUSION: Neoadjuvant chemoradiotherapy combined with surgery can achieve a higher R0 resection rate and higher OS and DFS than other treatments, representing an effective method for stage Ⅱ-Ⅲ rectal cancer. Neoadjuvant chemoradiotherapy without surgery, age and circumferential tumor are prognostic factors.
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