Detrimental immunologic effects of preoperative chemoradiotherapy in advanced rectal cancer.
OBJECTIVE
Preoperative chemoradiotherapy for advanced rectal cancer has been an important therapeutic tool to improve the long-term results of curative resection. It is not known whether preoperative chemoradiotherapy for advanced rectal cancer influences the perioperative course of immune parameters.


METHODS
Thirty patients with rectal cancer underwent surgery with (study group, n = 15) or without (control group, n = 15) preoperative chemoradiotherapy (2 cycles of 5-fluorouracil, 45 Gy). Blood samples were taken before neoadjuvant therapy, preoperatively, and on Days 1, 2, and 5 after surgery. Cell numbers of lymphocyte subpopulations, granulocytes, monocytes, and natural killer cells were determined by flow cytometry; tumor necrosis factor-alpha and interleukin-6 serum levels were measured with enzyme-linked immunosorbent assay.


RESULTS
Significant differences between study and control patients (P < 0.05) were detected regarding circulating interleukin-6 and tumor necrosis factor-alpha levels, with depression of the proinflammatory response to surgery in study patients. Similarly, granulocytosis and monocytosis after surgery were significantly lower in patients after neoadjuvant therapy. Furthermore, cell counts of total T lymphocytes, T helper cells, B lymphocytes, and natural killer cells were significantly reduced after preoperative chemoradiotherapy. This depression of cell-mediated immunity in study patients was even more pronounced after surgery.


CONCLUSIONS
Preoperative chemoradiotherapy for advanced rectal cancer results in a significant preoperative and postoperative immune dysfunction as indicated by depression of lymphocyte subpopulations, monocytes, granulocytes, and proinflammatory cytokine release. These findings are of importance because increased perioperative morbidity and mortality rates have been observed after preoperative chemoradiotherapy.
Wichmann
Matthias W
MW
Department of Surgery, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany.
Meyer
Günther
G
Adam
Michaela
M
Höchtlen-Vollmar
Wilma
W
Angele
Martin K
MK
Schalhorn
Andreas
A
Wilkowski
Ralf
R
Müller
Christian
C
Schildberg
Friedrich-Wilhelm
FW
D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects*; D003082:Colectomy; D005260:Female; D006801:Humans; D007111:Immunity, Cellular / Q000187:drug effects / Q000502:physiology / Q000528:radiation effects; D016867:Immunocompromised Host / Q000276:immunology*; D015850:Interleukin-6 / Q000097:blood / Q000276:immunology; D016131:Lymphocyte Subsets; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D011300:Preoperative Care; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects*; D012004:Rectal Neoplasms / Q000276:immunology* / Q000601:surgery / Q000628:therapy*; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis / Q000276:immunology / Q000378:metabolism
D000970:Antineoplastic Agents; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha