Preoperative Concurrent Chemoradiotherapy Combined with Total Mesorectal Excision in Treatment for Locally Advanced Lower Rectal Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Ang , CAO Feng , FANG Yu , LI Jia , ZHANG Yupeng , LIU Diangang , LI Fei

Department of General Surgery， Xuanwu Hospital of Capital Medical University， Beijing 100053， China;

Corresponding author：

Keywords：

Rectal cancer; Preoperative chemoradiotherapy; Total mesorectal excision

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Objective 　To evaluate the efficacy of preoperative concurrent chemoradiotherapy combined with total mesorectal excision （TME） in treatment for locally advanced lower rectal cancer.
Methods 　The clinical data of 31 patients with locally advanced lower rectal cancer received concurrent chemoradiotherapy from January 2009 to December 2011 in this hospital were analyzed retrospectively. Conventional fraction radiotherapy with total dose 50 Gy and chemotherapy with mFOLFOX6 or CapeOX regimen were taken. The efficacy was assessed by recording results of clinical and pathological examination. The function of sphincter was also recorded.
Results 　All 31 patients underwent TME operation. The complication morbidity and mortality was 12.9% （4/31） and 3.2% （1/31），respectively. As a result of the preoperative management，the tumor was reduced by an average of 21.9%， down-regulation of T stage was observed in 48.4% （15/31） patients，the frequency of lymph node metastasis decreased from 83.9% （26/31） to 38.7% （12/31）. Pathological complete response was observed in 5 patients （16.1%） and the total response rate was 74.2% （23/31），grade 3/4 toxicity was occurred in 2 （6.5%） patients. 84.6% （22/26） of patients underwent sphincter preservation surgery reserved good function of sphincter.
Conclusions 　Preoperative concurrent chemoradiotherapy combined with TME in treatment for locally advanced lower rectal cancer is effective and safe，which can lead to pathological complete response，decrease the tumor stage and the rate of lymph node metastasis，and can also increase the efficacy of operation.

Citation： LI Ang,CAO Feng,FANG Yu,LI Jia,ZHANG Yupeng,LIU Diangang,LI Fei. Preoperative Concurrent Chemoradiotherapy Combined with Total Mesorectal Excision in Treatment for Locally Advanced Lower Rectal Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2012, 19(9): 971-974. doi: Copy

1.	Heald RJ， Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer[J]. Lancet， 1986， 1(8496)：1479-1482.
2.	Peeters KC， Marijnen CA， Nagtegaal ID， et al. The TME trial after a median follow-up of 6 years：increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma[J]. Ann Surg， 2007， 246(5)：693-701.
3.	Gérard JP， Conroy T， Bonnetain F， et al. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers：results of FFCD 9203[J]. J Clin Oncol， 2006， 24(28)：4620-4625.
4.	Ceelen WP， van Nieuwenhove Y， Fierens K. Preoperative chemoradiation versus radiation alone for stageⅡandⅢresectable rectal cancer[J]. Cochrane Database Syst Rev， 2009(1)：CD06041.
5.	Bosset JF， Collette L， Calais G， et al. Chemotherapy with preoperative radiotherapy in rectal cancer[J]. N Engl J Med， 2006， 355(11)：1114-1123.
6.	Eisenhauer EA， Therasse P， Bogaerts J， et al. New response evaluation criteria in solid tumours：revised RECIST guideline (version 1.1)[J]. Eur J Cancer， 2009， 45(2)：228-247.
7.	Dworak O， Keilholz L， Hoffmann A. Pathological features of rectal cancer after preoperative radiochemotherapy[J]. Int J Colorectal Dis， 1997， 12(1)：19-23.
8.	Williams NS， Patel J， George RD， et al. Development of an electrically stimulated neoanal sphincter[J]. Lancet， 1991， 338(8776)：1166-1169.
9.	Ortholan C， Francois E， Thomas O， et al. Role of radiotherapy with surgery for T3 and resectable T4 rectal cancer：evidence from randomized trials[J]. Dis Colon Rectum， 2006， 49(3)：302-310.
10.	Enríquez-Navascués JM， Borda N， Lizerazu A， et al. Patternsof local recurrence in rectal cancer after a multidisciplinaryapproach[J]. World J Gastroenterol， 2011， 17(13)：1674-1684.
11.	National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Gudielines in Oncology——Rectal Cancer. http：//www.nccn.org/professionals/physician_gls/pdf/rectal.pdf.
12.	肖毅. 直肠癌新辅助治疗[J]. 中国普外基础与临床杂志， 2010， 17(9)：906-909.
13.	Bosset JF， Calais G， Mineur L， et al. Enhanced tumorocidal effect of chemotherapy with preoperative radiotherapy for rectal cancer：preliminary results——EORTC 22921[J]. J Clin Oncol， 2005， 23(24)：5620-5627.
14.	于波，金伟森，李世拥，等. T3期中低位直肠癌同步放化疗后行保肛手术的临床研究[J]. 结直肠肛门外科， 2009， 15(4)：221-223.
15.	柴宇啸，曲兴龙，王奕静，等. 同步新辅助放化疗联合全直肠系膜切除术治疗中低位局部进展期直肠癌的临床研究[J]. 肿瘤， 2011， 31(7)：658-661.
16.	Swedish Rectal Cancer Trial. Improved survival with preoperative radiotherapy in resectable rectal cancer[J]. N Engl J Med， 1997， 336：980-987.
17.	Birgisson H， Påhlman L， Gunnarsson U， et al. Adverse effects of preoperative radiation therapy for rectal cancer：long-term follow-up of the Swedish Rectal Cancer Trial[J]. J Clin Oncol， 2005， 23(34)：8697-8705.
18.	Sebag-Montefiore D， Stephens RJ， Steele R， et al. Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016)：a multicentre， randomised trial[J]. Lancet， 2009， 373(9666)：811-820.
19.	Stephens RJ， Thompson LC， Quirke P， et al. Impact of short-course preoperative radiotherapy for rectal cancer on patients’ quality of life：data from the Medical Research Council CR07/National Cancer Institute of Canada Clinical Trials Group C016 randomized clinical trial[J]. J Clin Oncol， 2010， 28(27)：4233-4239.
20.	Sauer R， Liersch T， Merkel S， et al. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer：results of the German CAO/ARO/AIO-94 randomized phaseⅢtrial after a median follow-up of 11 years[J]. J Clin Oncol， 2012， 30(16)：1926-1933.
21.	Roh MS， Yothers GA， O’Conneu MJ， et al. The impact of capecitabine and oxaliplatin in the preoperative multimodality treatment in patients with carcinoma of the rectum：NSABP R-04 [J]. J Clin Oncol， 2011， 29(Suppl)：abstr 3503.
22.	Tulchinsky H， Shmueli E， Figer A， et al. An interval ＞7 weeks between neoadjuvant therapy and surgery improves pathologic complete response and disease-free survival in patients with locally　advanced rectal cancer[J]. Ann Surg Oncol， 2008， 15(10)：2661-2667.

1. Heald RJ， Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer[J]. Lancet， 1986， 1(8496)：1479-1482.
2. Peeters KC， Marijnen CA， Nagtegaal ID， et al. The TME trial after a median follow-up of 6 years：increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma[J]. Ann Surg， 2007， 246(5)：693-701.
3. Gérard JP， Conroy T， Bonnetain F， et al. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers：results of FFCD 9203[J]. J Clin Oncol， 2006， 24(28)：4620-4625.
4. Ceelen WP， van Nieuwenhove Y， Fierens K. Preoperative chemoradiation versus radiation alone for stageⅡandⅢresectable rectal cancer[J]. Cochrane Database Syst Rev， 2009(1)：CD06041.
5. Bosset JF， Collette L， Calais G， et al. Chemotherapy with preoperative radiotherapy in rectal cancer[J]. N Engl J Med， 2006， 355(11)：1114-1123.
6. Eisenhauer EA， Therasse P， Bogaerts J， et al. New response evaluation criteria in solid tumours：revised RECIST guideline (version 1.1)[J]. Eur J Cancer， 2009， 45(2)：228-247.
7. Dworak O， Keilholz L， Hoffmann A. Pathological features of rectal cancer after preoperative radiochemotherapy[J]. Int J Colorectal Dis， 1997， 12(1)：19-23.
8. Williams NS， Patel J， George RD， et al. Development of an electrically stimulated neoanal sphincter[J]. Lancet， 1991， 338(8776)：1166-1169.
9. Ortholan C， Francois E， Thomas O， et al. Role of radiotherapy with surgery for T3 and resectable T4 rectal cancer：evidence from randomized trials[J]. Dis Colon Rectum， 2006， 49(3)：302-310.
10. Enríquez-Navascués JM， Borda N， Lizerazu A， et al. Patternsof local recurrence in rectal cancer after a multidisciplinaryapproach[J]. World J Gastroenterol， 2011， 17(13)：1674-1684.
11. National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Gudielines in Oncology——Rectal Cancer. http：//www.nccn.org/professionals/physician_gls/pdf/rectal.pdf.
12. 肖毅. 直肠癌新辅助治疗[J]. 中国普外基础与临床杂志， 2010， 17(9)：906-909.
13. Bosset JF， Calais G， Mineur L， et al. Enhanced tumorocidal effect of chemotherapy with preoperative radiotherapy for rectal cancer：preliminary results——EORTC 22921[J]. J Clin Oncol， 2005， 23(24)：5620-5627.
14. 于波，金伟森，李世拥，等. T3期中低位直肠癌同步放化疗后行保肛手术的临床研究[J]. 结直肠肛门外科， 2009， 15(4)：221-223.
15. 柴宇啸，曲兴龙，王奕静，等. 同步新辅助放化疗联合全直肠系膜切除术治疗中低位局部进展期直肠癌的临床研究[J]. 肿瘤， 2011， 31(7)：658-661.
16. Swedish Rectal Cancer Trial. Improved survival with preoperative radiotherapy in resectable rectal cancer[J]. N Engl J Med， 1997， 336：980-987.
17. Birgisson H， Påhlman L， Gunnarsson U， et al. Adverse effects of preoperative radiation therapy for rectal cancer：long-term follow-up of the Swedish Rectal Cancer Trial[J]. J Clin Oncol， 2005， 23(34)：8697-8705.
18. Sebag-Montefiore D， Stephens RJ， Steele R， et al. Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016)：a multicentre， randomised trial[J]. Lancet， 2009， 373(9666)：811-820.
19. Stephens RJ， Thompson LC， Quirke P， et al. Impact of short-course preoperative radiotherapy for rectal cancer on patients’ quality of life：data from the Medical Research Council CR07/National Cancer Institute of Canada Clinical Trials Group C016 randomized clinical trial[J]. J Clin Oncol， 2010， 28(27)：4233-4239.
20. Sauer R， Liersch T， Merkel S， et al. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer：results of the German CAO/ARO/AIO-94 randomized phaseⅢtrial after a median follow-up of 11 years[J]. J Clin Oncol， 2012， 30(16)：1926-1933.
21. Roh MS， Yothers GA， O’Conneu MJ， et al. The impact of capecitabine and oxaliplatin in the preoperative multimodality treatment in patients with carcinoma of the rectum：NSABP R-04 [J]. J Clin Oncol， 2011， 29(Suppl)：abstr 3503.
22. Tulchinsky H， Shmueli E， Figer A， et al. An interval ＞7 weeks between neoadjuvant therapy and surgery improves pathologic complete response and disease-free survival in patients with locally　advanced rectal cancer[J]. Ann Surg Oncol， 2008， 15(10)：2661-2667.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Preoperative Concurrent Chemoradiotherapy Combined with Total Mesorectal Excision in Treatment for Locally Advanced Lower Rectal Cancer

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