Long-term oncologic results and complications after preoperative chemoradiotherapy for rectal cancer: a single-institution experience after a median follow-up of 95 months.
BACKGROUND
This study sought to evaluate the long-term outcome and complications, and occurrence of second malignancy after preoperative chemoradiotherapy (pCRT) for rectal cancer.


METHODS
One hundred twenty-three consecutive patients (78 men, 45 women) with locally advanced mid-low rectal cancer underwent pCRT between 1994 and 2002. Patients were followed up by one surgeon with a standard protocol, and data were prospectively recorded in a dedicated database. No patient was lost to follow-up. Complications were defined as late if they occurred >6 months after surgery. Overall and disease-free survival were calculated by the Kaplan-Meier method.


RESULTS
Of 123 patients, 111 underwent an R0 procedure. The rate of pathologic complete response was 16% (n = 20 patients). At a median follow-up of 95 (range, 56-160) months, 50 late complications occurred in 41 patients, 21 of whom required surgery. In seven cases, the complications were clearly CRT related and were significantly associated with the total dose of radiation delivered (P < .05). The estimated 5- and 10-year overall survival was 76% and 67%, respectively. The estimated 5- and 10-year disease-free survival was 83% and 82%, respectively. In 18 of 19 patients who experienced recurrence (local, n = 3; distant, n = 16), it occurred within 48 months from surgery. The most frequent site of metastasis as first site of recurrence was the lung (9 of 19). The most frequent second primary malignancy was lung cancer (3 of 8).


CONCLUSIONS
Despite satisfactory oncological outcome, late morbidity after pCRT is relevant and related to the radiotherapy dose used. Most recurrences and second malignancies were located in the lung.
Pucciarelli
Salvatore
S
Department of Oncological and Surgical Sciences, Clinica Chirurgica II, University of Padova, Padua, Italy. puc@unipd.it
Gagliardi
Giuseppe
G
Maretto
Isacco
I
Lonardi
Sara
S
Friso
Maria Luisa
ML
Urso
Emanuele
E
Toppan
Paola
P
Nitti
Donato
D
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D003082:Colectomy / Q000009:adverse effects; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011379:Prognosis; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects*; D012004:Rectal Neoplasms / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome