Evaluation of DOWNSTAGING as leading concept in sphincter-saving surgery for rectal cancer after preoperative radio-chemotherapy (Preop RCT).
OBJECTIVE
To evaluate the downstaging of rectal cancer after preop R +/- CT.


METHODS
392 patients (pts) with rectal cancer were observed. Only 172 pts (58%) with II and III stage cancer of middle and lower third were examined. Enrol-led pts were 168: 52 of them received preop R +/- CT (32 RT, 20 R + CT). Preop R +/- CT group included 14 middle third cancers (73%), 38 lower third (17%). In this group, tumor stage was as follows: 44 T3 stage tumors (86.4%), 8 (15.4%) T4. Mean age of this group was 57 years (range 42-67). Patients received 45 Gy for 5 weeks in 25 fractions and continuous administration of 5-FU (300-500 mg/m2/die). Surgery was performed 6 weeks +/- 7 days after the therapy.


RESULTS
Downstaging, at least of 1 T-stage level, was detected in 45 patients (86%) (8 middle third; 32 lower third), in 5 (9.6%) (4 middle third, 1 lower third), tumor decreased to pT0N0, while in 7 (13.5%) (2 middle third, 5 lower third), there was no response. An Anterior Resection (AR) was performed in 40 patients (77%) [4 Downstaged to pT0N0 middle third cancers; 36 downstaged but with residual disease (8 middle third, 28 lower third)]; APR was performed in 12 (23%) (7 No responders patients, 1 Downstaged to pT0N0 lower third cancer, 4 downstaged but with residual disease of lower third).


CONCLUSIONS
Preop R +/- CT is effective in obtaining a significative downstaging to allow sphincter saving surgery, without compromising oncological results.
Gentile
M
M
Department of General, Geriatric and Oncological Surgery and Advanced Techniques, University of Naples "Federico II", Italy. magentil@unina.it
Bucci
L
L
Cerbone
D
D
D'Antonio
D
D
Guarino
V
V
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005472:Fluorouracil / Q000008:administration & dosage / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011300:Preoperative Care; D011879:Radiotherapy Dosage; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D012007:Rectum / Q000473:pathology; D013997:Time Factors
D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil