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Chemoradiation instead of surgery to treat mid and low rectal tumors: Is it safe?

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Abstract

Background

The main treatment for rectal carcinoma is surgery. Preoperative chemoradiation (CRT) is advocated to reduce local recurrence and improve resection of mid and low tethered rectal tumors.

Methods

Fifty-two patients with mid or low rectal tumors underwent CRT (external beam radiation plus 5-fluorouracil plus folinic acid). Patients who had low rectal tumors with complete response (CR) were not submitted to surgical treatment. All other patients were submitted to surgery, independently of the response. Mean follow-up was 32.1 months.

Results

Five-year overall survival was 60.5%. Clinical evaluation after CRT showed CR in 10 cases (19.2%), all low tumors; incomplete response (>50%) in 21 (40.4%); and no response to 8.8 months. Two patients were not submitted to surgery and are still alive without cancer after 37 and 58 months. Thirty-nine patients had radical surgery. Seven had local recurrences after CRT plus surgery (17.9%). Overall survival was negatively affected by lymph node metastases (P=.017) and perineural invasion (P=.026).

Conclusions

Exclusive CRT approach is not safe to treat patients with low infiltrative rectal carcinoma.

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Authors and Affiliations

  1. Pelvic Surgery Department, A. C. Camargo Cancer Hospital, Antonio Prudente Foundation, São Paulo, Brazil

    Wilson T. Nakagawa MD, Benedito M. Rossi MD, PhD, FACS, CSSO, Fábio de O. Ferreira MD, PhD, Robson Ferrigno MD, Waldec J. David Filho MD, Inês N. Nishimoto MSc, Rene A. C. Vieira MD & Ademar Lopes MD, PhD, FACS, FSSO

Authors
  1. Wilson T. Nakagawa MD
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  2. Benedito M. Rossi MD, PhD, FACS, CSSO
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  3. Fábio de O. Ferreira MD, PhD
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  4. Robson Ferrigno MD
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  5. Waldec J. David Filho MD
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  6. Inês N. Nishimoto MSc
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  7. Rene A. C. Vieira MD
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  8. Ademar Lopes MD, PhD, FACS, FSSO
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Correspondence to Wilson T. Nakagawa MD.

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Nakagawa, W.T., Rossi, B.M., Ferreira, F.d.O. et al. Chemoradiation instead of surgery to treat mid and low rectal tumors: Is it safe?. Annals of Surgical Oncology 9, 568–573 (2002). https://doi.org/10.1007/BF02573893

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  • DOI: https://doi.org/10.1007/BF02573893

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