[The role of neoadjuvant radio-chemotherapy in the treatment of rectal cancer].
OBJECTIVE
To evaluate oncological and surgical outcome of patients submitted to neoadjuvant therapy for advanced rectal cancer.


METHODS
One hundred thirty eight patients (86 male, 52 female, mean age 61.4 years), with tumour of lower (58; 42%), middle (66; 48%), upper rectum (14; 10%), showing a clinical stage II (23; 17%) or III (115; 83%) and with an average distance from anal verge of 6.5 cm, submitted to fractionated "long-course" RT with CT locally staged by US and MR before and after neoadjuvant therapy and operated on after 4-6 weeks by its end.


RESULTS
Surgical procedures (71 of which laparoscopic) were: 114 AR (83.8%), 19 APR (14%) and 3 TEM (2.2%). Mean nodal-sampling was 14.9. A complete or partial response was observed in 48.5% of the patients (67/138). With a mean follow-up of 30 months, local recurrence rate was 5.7%. Five-years overall survival and disease-fee-survival were respectively 73% and 60%.


CONCLUSIONS
We observed a significant clinical (p < 0.004) and pathological (p < 0.005) downstaging. Pre-treatment clinical stage was not significant. On the contrary, postoperative yTNM was significant for yT (p < 0.001) and yN (p < 0.0003). Non-responder patients had worse prognosis (5-years survival 30%). The variable with higher prognostic significance was yN (p < 0.0003), especially if we distinguish N1 by N2 (p < 0.0004).


CONCLUSIONS
The response to neoadjuvant therapy represents a significant prognostic variable.
Dipartimento Assistenziale di Scienze Chirurgiche, Università Vita-Salute S. Raffaele, Milano.
Carlo
C
Staudacher
Saverio
S
Di Palo
Andrea Marco
AM
Tamburini
Andrea
A
Vignali
Elena
E
Orsenigo
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009367:Neoplasm Staging; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D012189:Retrospective Studies; D016019:Survival Analysis