title: [Effectiveness of preoperative chemoradiotherapy for advanced rectal cancer].
abstract: To determine the pathologic effectiveness of preoperative chemoradiotherapy (CRT) in patients with advanced rectal carcinoma, we reviewed clinical records of 76 patients who received preoperative pelvic radiation +/- chemotherapy. Since 2 patients refused operation and 2 died before surgery, 72 patients underwent operation with a mean delay of 19.9 days after completion of irradiation. Pathologic tumor regression grade (Grade 0-3) was determined by the amount of viable tumor versus necrosis and fibrosis. Grade 0, 1 a, 1 b, 2, and 3 (pCR) were observed in 0%, 25.0%, 38.9%, 27.8% and 2.8% of patients, respectively. The pathologic response (PR) rate was 75.0% when PR was defined as greater than grade 1 b (tumor regression more than 1/3). Downstaging was observed in 35.8% of patients, in which 5-year overall survival was significantly better than in patients without downstaging (90.0% vs. 50.1%, p<0.05). No correlation could be observed between PR and downstaging. CRT is a useful tool with a high PR rate in patients with advanced rectal cancer. More accurate and careful clinical staging is important to select adequate candidates for CRT. Multi-institutional clinical trials as well as standardizing the surgical procedure including LN dissection are required to validate the advantages of CRT for Japanese patients.
authors.affiliation: Dept. of Surgery, Mitoyo General Hospital.
authors.forename: Masaomi
authors.initials: M
authors.lastname: Yamane
authors.forename: Minoru
authors.initials: M
authors.lastname: Mizuta
authors.forename: Mitsumasa
authors.initials: M
authors.lastname: Kaji
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Toyokawa
authors.forename: Katsuya
authors.initials: K
authors.lastname: Miyatani
authors.forename: Tetsunobu
authors.initials: T
authors.lastname: Udaka
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Kubo
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Hosokawa
authors.forename: Kinichiro
authors.initials: K
authors.lastname: Suwaki
authors.forename: Kazutoyo
authors.initials: K
authors.lastname: Shirakawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant; D004334:Drug Administration Schedule; D005260:Female; D005467:Floxuridine / Q000008:administration & dosage; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D010388:Pelvis / Q000528:radiation effects; D011300:Preoperative Care; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D012007:Rectum / Q000601:surgery*; D015996:Survival Rate
chemical_list: D000964:Antimetabolites, Antineoplastic; D005467:Floxuridine; D005472:Fluorouracil; C025034:doxifluridine