Il ruolo della radiochemioterapia neoadiuvante nel trattamento del tumore del retto


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

Ann. Ital. Chir., 2007; 78: 493-498

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