Preoperative chemoradiotherapy and radical surgery for locally advanced distal rectal adenocarcinoma

• DOI: 10.1007/bf02234632
• Publication Date: 2005-11-14T20:58:38Z
• Authors: David Medich; James McGinty; David Parda; Stephen Karlovits; Chris Davis; Philip Caushaj; Barry Lembersky
• Keywords: Chemoradiotherapy; Radical surgery; Colorectal Surgery; Surgical oncology

Preoperative chemoradiotherapy followed by radical surgical resection has been the preferred treatment for patients presenting with locally advanced distal rectal carcinoma at our institutions. We postulated that chemoradiotherapy-induced pathologic response of primary tumor would identify which be candidates local excision as definitive therapy.A retrospective analysis 60 palpable, advanced, adenocarcinomas treated from 1995 to 2000 was performed. All received preoperative consisting 5-fluorouracil (325 mg/m(2)) and leucovorin (20 bolus infusion on Days 1 through 5 29 33 delivered concurrently least 45.0 50.4 Gy pelvic radiation, six eight weeks later surgery then adjuvant chemotherapy.Among females) there a mean age 58.7 (28-84) years. Clinical staging follows: Stage II, 14 (23 percent); III, 35 (58 IV, 11 (18 percent). Pathologic examination revealed negative margins were obtained in 58 (97 Downstaging T0-2N0 achieved 17 (28 percent), five (8 percent) achieving pathologically complete response. Lymph nodes positive 24 (40 despite chemoradiotherapy. node positivity found 0 pT0 patients, 9 (41 22 pT1 or pT2, 15 (45 pT3. stage, size, adverse histologic features could not reliably predict pN0 status, except (5 only).Preoperative often downsizes downstages carcinoma. Neither pretreatment clinical characteristics, chemoradiotherapy, status. Therefore, is recommended an alternative adenocarcinoma rectum regardless