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Long Term Outcomes of Preoperative versus Postoperative Concurrent Chemoradiation for Locally Advanced Rectal Cancer: Experience from Ramathibodi Medical School in Thailand

  • Darunikorn, Pichayada (Radiation and Oncology Unit, Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University) ;
  • Puataweepong, Putipun (Radiation and Oncology Unit, Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University) ;
  • Dhanachai, Mantana (Radiation and Oncology Unit, Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University) ;
  • Dangprasert, Somjai (Radiation and Oncology Unit, Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University) ;
  • Swangsilpa, Thiti (Radiation and Oncology Unit, Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University) ;
  • Sitathanee, Chomporn (Radiation and Oncology Unit, Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University) ;
  • Jiarpinitnun, Chuleeporn (Radiation and Oncology Unit, Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University) ;
  • Pattaranutaporn, Poompis (Radiation and Oncology Unit, Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University) ;
  • Boonyawan, Keeratikan (Radiation and Oncology Unit, Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University) ;
  • Chansriwong, Pichai (Medical Oncology Unit, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University)
  • Published : 2015.11.04

Abstract

Objectives: The study analyzed and compared the long term outcome in locally advanced rectal cancer treated with preoperative and postoperative concurrent chemoradiation (CCRT). Materials and Methods: A retrospective review of 105 patients with stage T3-T4 or regional lymph node positive adenocarcinoma of rectum treated with preoperative or postoperative CCRT at Ramathibodi Hospital during 2005 to 2010 was performed. The results of treatment were reported with 5-year overall survival (OS), 5-year locoregional recurrence free survival (LRFS), and toxicity according to preoperative versus postoperative concurrent chemoradiation (CCRT) groups. Results: Among 105 patients, 34 (32%) were treated with preoperative CCRT and 71 (68%) with postoperative CCRT. At the median follow-up time of 50.5 months (range 2-114 months), five-year OS and LRFS of all patients were 87% and 91.6%, respectively. The study found no difference in 5-year OS (81.7% vs 89.2 %) or LRFS (83.4% vs 95.1%) between preoperative versus postoperative CCRT. Seven cases of loco-regional recurrence were diagnosed, 4 (11.8%) after preoperative CCRT and 3 (4.2%) after postoperative CCRT. The recurrent sites were anastomosis in all patients. There was no significant factor associated with outcome after univariate and multivariate testing. Grade 3 or 4 acute and late complications were low in both preoperative and postoperative CCRT groups. Conclusions: Locally advanced rectum cancer patients experience good results with surgery and adjuvant concurrent chemoradiation.

Keywords

Rectal cancer;chemoradiation;locally advanced;outcome

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