The role of the neoadjuvant chemotherapy in the treatment of the tumor of rectal cancer

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Carlo Staudacher
Saverio Di Palo
Andrea Marco Tamburini
Andrea Vignali
Elena Orsenigo

Abstract

OBJECTIVE: To evaluate oncological and surgical outcome of patients submitted to neoadjuvant therapy for advanced rectal cancer.


PATIENTS AND METHOD: One hundred thirty eight patients (86 male, 52 female, mean age 61.4 years), with tumour of lower (58; 42%), middle (66; 48%), upper rectum (14; 10%), showing a clinical stage II (23; 17%) or III ( 115; 83%) and with an average distance from anal verge of 6.5 cm, submitted to fractionated “long-course” RT with CT, locally staged by US and MR before and after neoadjuvant therapy and operated on after 4-6 weeks by its end.


RESULTS: Surgical procedures (71 of which laparoscopic) were: 114 AR (83.8%), 19 APR (14%) and 3 TEM (2.2%). Mean nodal-sampling was 14.9. A complete or partial response was observed in 48.5% of the patients (67/138). With a mean follow-up of 30 months, local recurrence rate was 5.7%. Five-years overall survival and disease-free-survival were respectively 73% and 60%.


DISCUSSION: We observed a significant clinical (p < 0.004) and pathological (p < 0.005) downstaging. Pre-treatment clinical stage was not significant. On the contrary, postoperative yTNM was significant for yT (p < 0.001) and yN (p < 0.0003). Non-responder patients had worse prognosis (5-years survival 30%). The variable with higher prognostic significance was yN (p < 0.0003), especially if we distinguish N1 by N2 (p < 0.0004).


CONCLUSIONS: The response to neoadjuvant therapy represents a significant prognostic variable.

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How to Cite
Staudacher, Carlo, et al. “The Role of the Neoadjuvant Chemotherapy in the Treatment of the Tumor of Rectal Cancer”. Annali Italiani Di Chirurgia, vol. 78, no. 6, Nov. 2007, pp. 493-8, https://annaliitalianidichirurgia.it/index.php/aic/article/view/2444.
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