Neoadjuvant Radiochemotherapy in the Multidisciplinary Treatment of Rectal Cancer
Piero Rossi, Flavio De Sanctis, Edoardo Ricciardi, Mauro Montuori, Valerio Balassone, Giampiero Palmieri, Michaela Benassi, Matteo Vergati, Mario Roselli and Giuseppe Petrella
World Journal of Surgical Medical and Radiation Oncology 2013, 2:3
Rectal cancer is one of the most common malignancies in the Western world. More than 50% of tumours are diagnosed at a locally advanced stage. The multidisciplinary approach is the gold standard in the treatment of rectal cancer. With total mesorectal excision (TME), introduced by Heald R. J, and the development of specific neoadjuvant radiochemotherapy treatments (NRCT), a significant impact in local recurrence rates, downsizing, down staging, clinical complete response (cCR) and pathological complete response (pCR) has been reached. NRCT and surgery are the most important determinants in reaching pCR and local control of disease.
Materials and Methods
A total of 11 patients (with stage II and III rectal cancer treated in our Institute between 2004 and 2011 were included in our study: 5 males and 6 females, average age 67,82 (range 54-77 years). In all patients, the diagnosis was performed with colonoscopy and histology. The staging in all patients was carried out with a total body CT scan and a trans-rectal ultrasound examination. All patients underwent long-course neoadjuvant radio-chemotherapy (details in table).
All but one of the patients is still alive. No patient had local recurrence at follow up; pCR was observed in 4 patients; downstaging was seen in 5 patients; no response was observed in 2 patients. The results of the multidisciplinary treatment of our cases are shown in table 1. In 4 cases, it was necessary to briefly discontinue the NRCT treatment due to toxicity. We had no complications in the peri-operative period. One male patient is suffering “impotentia erigendi”, and 2 patients report impaired defecation.
Treatment of rectal cancer has dramatically improved over the last twenty years. Before the introduction of TME, the local recurrence rates were between 20 and 40%. In recent decades, NRCT has emerged in the treatment of stage II-III rectal cancer. In particular, the EORTC study showed that the association of NRCT treatment combined with surgery has a considerable impact about reduction of local recurrence rates: they are at 7.6%. NRCT is well tolerated by patients. We can state the efficacy of NRCT in the absence of correlated peri-operative morbidity.