Role of Preoperative Chemoradiotherapy in Downstaging Locally Advanced Rectal Cancer
European Journal of Molecular & Clinical Medicine,
2022, Volume 9, Issue 5, Pages 565-574
AbstractBackground: Neoadjuvant chemotherapy is frequently used in the treatment of a number of solid tumour malignancies, although its effectiveness in treating locally advanced colorectal cancers is yet unknown. We in the current study tried to assess the complications of neoadjuvant chemoradiotherapy in rectal cancer and to assess response to neoadjuvant chemoradiotherapy.
Methods: All patients with carcinoma rectum who presented to MNJ Institute of Oncology and Regional Cancer Center was evaluated by clinical examination, sigmoidoscopy or colonoscopy, staged by MRI pelvis and CT chest and abdomen. Based on the findings, patients with tumors assessed as locally advanced (T3 and T4, N+) are sent for neoadjuvant therapy with concurrent chemoradiotherapy or radiotherapy. N=72 patients with locally advanced carcinoma rectum were identified for the study and referred for neoadjuvant chemoradiation.
Results: Response to Neoadjuvant chemoradiotherapy (NACRT) N=8 patients had clinically progressed while on neoadjuvant chemoradiotherapy, both locoregionally and also developed systemic metastases. Response assessment was done using MRI before NACRT and before surgery. Patients with locally advanced rectal cancer with involvement of mesorectal fascia or loss of fatty plane with prostate or vagina preoperatively had post-radiotherapy changes suggestive of fibrosis. All the n=54 patients (including those who did not consent to surgery) showed radiological response though downstaging did not occur in all the cases.
Conclusion: In this study, the pathologic complete remission using this combined modality was 4%. The pathologic downstaging effect was 48%, including pathologic complete response. Complications especially when extra levator excision is done and reconstruction is performed are fraught with prolonged morbidity. Neoadjuvant chemoradiotherapy as part of a multimodality treatment strategy for locally advanced rectal cancer is safe with acceptable morbidity. Oncologic outcomes in the form of margins were good.
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