title: The outcomes of therapeutic decision in lower 3rd rectal cancer patients.
abstract: To investigate the outcomes of the selective neoadjuvant concurrent chemoradiotherapy (CCRT) in lower 3rd rectal cancer patients in different groups (with or without neoadjuvant CCRT), especially in survival rate, local recurrence rate, and sphincter preservation rate.From January 1999 to December 2012, 69 consecutive patients who had histologically proven adenocarcinoma of lower 3rd rectum, defined preoperatively as lower tumor margin within 7 cm from the anal verge as measured by rigid sigmoidoscopy, received total mesorectum excision (TME). Our inclusion criteria of neoadjuvant CCRT are lower 3rd rectal cancer, stage II/III, and large (diameter >5 cm or >1/2 of circumference). Neoadjuvant concurrent CCRT had begun to apply lower 3rd rectal cancer patients or not. The radiation techniques of neoadjuvant CCRT for lower 3rd rectal cancer patients were all conventional fraction intensity modulated radiotherapy (IMRT) and concurrent fluoropyrimidine chemotherapy.Five-year overall survival rate, disease-free survival rate, and local recurrence rate for lower 3rd rectal cancer patients in group I were 51%, 45%, and 25%, respectively. On the contrary, 5-year overall survival rate, disease-free survival rate, and local recurrence rate for lower rectal cancer patients in group II were 70%, 70%, and 3%, respectively. The 5-year sphincter sparing rate was increased from 38.2% to 100% after the beginning of neoadjuvant CCRT. Analyzing local recurrence, overall survival rate, disease-specific survival rate, and sphincter sparing rate in group II were statistically significant superior to group I.Five-year overall survival rate, disease-free survival rate, and sphincter sparing rate for lower 3rd rectal cancer patients were improved after the addition of neoadjuvant CCRT. No unacceptable toxicity was noted after conventional fraction IMRT and concurrent fluoropyrimidine chemotherapy. Our study showed neoadjuvant CCRT could be valuable for lower 3rd rectal cancer patients.
authors.affiliation: Department of Colorectal Surgery, Wan Fang Hospital Department of Surgery, College of Medicine Division of General Surgery, Department of Surgery Cancer Center, Taipei Medical University Hospital Graduate Institute of Cancer Biology and Drug Discovery Department of General Surgery, Wan Fang Hospital, Taipei Medical University Department of Radiation Oncology, Taipei Medical University Hospital Institute of Toxicology, College of Medicine, National Taiwan University Department of Radiation Oncology, Wan Fang Hospital Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei Department of Biotechnology, Hungkuang University, Taichung, Taiwan.
authors.forename: Chien-Hsin
authors.initials: CH
authors.lastname: Chen
authors.forename: Po-Li
authors.initials: PL
authors.lastname: Wei
authors.forename: Mao-Chih
authors.initials: MC
authors.lastname: Hsieh
authors.forename: En-Kwang
authors.initials: EK
authors.lastname: Lin
authors.forename: Jeng-Fong
authors.initials: JF
authors.lastname: Chiou
authors.forename: Yen-Jung
authors.initials: YJ
authors.lastname: Lu
authors.forename: Szu-Yuan
authors.initials: SY
authors.lastname: Wu
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000628:therapy*; D000368:Aged; D059186:Chemoradiotherapy, Adjuvant; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000517:prevention & control*; D050397:Radiotherapy, Intensity-Modulated; D012004:Rectal Neoplasms / Q000401:mortality / Q000628:therapy*; D013624:Taiwan / Q000453:epidemiology