Evaluation of DOWNSTAGING as leading concept in sphincter-saving surgery for rectal cancer after Preoperative Radio-Chemotherapy (Preop RCT)

Abstract

Aim: To evaluate the downstaging of rectal cancer after preop R±CT.

Methods: 392 patients (pts) with rectal cancer were obser ved. Only 172 pts (58%) with II and III stage cancer of middle and lower third were examined. Enrol-led pts were 168: 52 of them received preop R±CT (32 RT, 20 R+CT). Preop R±CT group included 14 middle third cancers (73%), 38 lower third (17%). In this group, tumor stage was as follows: 44 T3 stage tumors (86.4%), 8 (15.4%) T4. Mean age of this group was 57 years (range 42-67). Patients received 45 Gy for 5 weeks in 25 fractions and continuous administration of 5-FU (300-500 mg/m2/die). Surgery was performed 6 weeks ± 7 days after the therapy.

Results: Downstaging, at least of 1 T-stage level, was detec ted in 45 patients (86%) (8 middle third; 32 lower third); in 5 (9.6%) (4 middle third, 1 lower third), tumor decrea sed to pT0N0, while in 7 (13.5%) (2 middle third, 5 lower third), there was no response. An Anterior Resection (AR) was performed in 40 patients (77%) [4 Downstaged to pT0N0 middle third cancers; 36 downstaged but with residual disease (8 middle third, 28 lower third)]; APR was performed in 12 (23%) (7 No responders patients, 1 Downstaged to pT0N0 lower third cancer, 4 downstaged but with residual disease of lower third).

Conclusions: Preop R±CT is effective in obtaining a signi ficative downstaging to allow sphincter saving surgery, without compromising oncological results.