gms | German Medical Science

Introduction: Recent studies have shown improved local control after preoperative radiochemotherapy (RCTX) in patients with locally advanced rectal carcinoma. However, no survival benefit was shown. Our aims were to determine the occurence of local recurrence, overall survival and the histopathological response for patients with rectal carcinoma treated with preoperative radiochemotherapy and to compare the results with a historical patients group, which was treated with adjuvant radiochemotherapy.

Methods: 104 patients with uT3 rectal carcinoma were treated with neoadjuvant RCTX between 1997 and 2001. Percutaneous radiotherapy consisted of 45 cGy. Chemotherapy with 5-FU was given as a continous infusion at a dose of 250 mg/m2/day. The median follow-up time was 55 months. Histopathological regression was evaluated in all specimens after tumor resection. The historical patients group treated with postoperative RCTX between 1988 and 1997 consisted of 114 patients with uT3 rectal carcinoma. The median follow-up time of this patients group was 100 months.

Results: The 5-year incidence of local recurrences was significantly less with 6% after preoperative RCTX and 15% after postoperative RCTX (p<0.05). The overall survival rates did not differ significantly in both patients groups (n.s.). Postoperative complications were not increased after preoperative RCTX (n.s.). Preoperative RCTX achieved significantly „down-sizing“ of the primary tumors (p<0.001), which resulted in an increased sphincter-preserving resection rate for tumors located at the distal third (p<0.002). Histopathological responders (42%) with less than 10% residual tumor had a significant improved 5-year overall survivalof 89% compared to 72% for histopathological non-responders (p=0.025) and was identified as an independant prognostic factor.

Conclusion:Significant improvement of overall survival was observed for patients with histopathological tumor response after neoadjuvant radiochemotherapy.