The role of the neoadjuvant chemotherapy in the treatment of the tumor of rectal cancer

Carlo Staudacher, Saverio Di Palo, Andrea Marco Tamburini, Andrea Vignali, Elena Orsenigo

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: TO evaluate oncological and surgical outcome of patients submitted to neoadjuvant therapy for advanced rectal cancer. PATIENTS AND METHOD: One hundred thirty eight patients (86 male, 52 female, mean age 61.4 years), with tumour of lower (58; 42%), middle (66; 48%), upper rectum (14; 10%), showing a clinical stage II (23; 17%) or III (115; 83%) and with an average distance from anal verge of 6.5 cm, submitted to fractionated "long-course" RT with CT, locally staged by US and MR before and after neoadjuvant therapy and operated on after 4-6 weeks by its end. RESULTS: Surgical procedures (71 of which laparoscopic) were: 114 AR (83.8%), 19 APR (14%) and 3 TEM (2.2%). Mean nodal-sampling was 14.9. A complete or partial response was observed in 48.5% of the patients (67/138). With a mean follow-up of 30 months, local recurrence rate was 5.7%. Five-years overall survival and disease-free-survival were respectively 73% and 60%. DISCUSSION: We observed a significant clinical (p <0.004) and pathological (p <0.005) downstaging Pre-treatment clinical stage was not significant. On the contrary, postoperative y TNM was significant for yT (p <0.001) and yN (p <0.0003). Non-responder patients had worse prognosis (5-years survival 30%). The variable with higher prognostic significance was yN (p <0.0003), especially if we distinguish N1 by N2 (p <0.0004). CONCLUSIONS: The response to neoadjuvant therapy represents a significant prognostic variable.

Original languageEnglish
Pages (from-to)493-498
Number of pages6
JournalAnnali Italiani di Chirurgia
Volume78
Issue number6
Publication statusPublished - Nov 2007

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Rectal Neoplasms
Neoadjuvant Therapy
Drug Therapy
Neoplasms
Survival
Therapeutics
Rectum
Disease-Free Survival
Recurrence

Keywords

  • Neoadjuvant therapy
  • Rectal cancer

ASJC Scopus subject areas

  • Surgery

Cite this

The role of the neoadjuvant chemotherapy in the treatment of the tumor of rectal cancer. / Staudacher, Carlo; Di Palo, Saverio; Tamburini, Andrea Marco; Vignali, Andrea; Orsenigo, Elena.

In: Annali Italiani di Chirurgia, Vol. 78, No. 6, 11.2007, p. 493-498.

Research output: Contribution to journalArticle

Staudacher, C, Di Palo, S, Tamburini, AM, Vignali, A & Orsenigo, E 2007, 'The role of the neoadjuvant chemotherapy in the treatment of the tumor of rectal cancer', Annali Italiani di Chirurgia, vol. 78, no. 6, pp. 493-498.
Staudacher, Carlo ; Di Palo, Saverio ; Tamburini, Andrea Marco ; Vignali, Andrea ; Orsenigo, Elena. / The role of the neoadjuvant chemotherapy in the treatment of the tumor of rectal cancer. In: Annali Italiani di Chirurgia. 2007 ; Vol. 78, No. 6. pp. 493-498.
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N2 - OBJECTIVE: TO evaluate oncological and surgical outcome of patients submitted to neoadjuvant therapy for advanced rectal cancer. PATIENTS AND METHOD: One hundred thirty eight patients (86 male, 52 female, mean age 61.4 years), with tumour of lower (58; 42%), middle (66; 48%), upper rectum (14; 10%), showing a clinical stage II (23; 17%) or III (115; 83%) and with an average distance from anal verge of 6.5 cm, submitted to fractionated "long-course" RT with CT, locally staged by US and MR before and after neoadjuvant therapy and operated on after 4-6 weeks by its end. RESULTS: Surgical procedures (71 of which laparoscopic) were: 114 AR (83.8%), 19 APR (14%) and 3 TEM (2.2%). Mean nodal-sampling was 14.9. A complete or partial response was observed in 48.5% of the patients (67/138). With a mean follow-up of 30 months, local recurrence rate was 5.7%. Five-years overall survival and disease-free-survival were respectively 73% and 60%. DISCUSSION: We observed a significant clinical (p <0.004) and pathological (p <0.005) downstaging Pre-treatment clinical stage was not significant. On the contrary, postoperative y TNM was significant for yT (p <0.001) and yN (p <0.0003). Non-responder patients had worse prognosis (5-years survival 30%). The variable with higher prognostic significance was yN (p <0.0003), especially if we distinguish N1 by N2 (p <0.0004). CONCLUSIONS: The response to neoadjuvant therapy represents a significant prognostic variable.

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