TY - JOUR
T1 - Neoadjuvant chemoradiation for rectal cancer
T2 - Analysis of clinical outcomes from a 13-year institutional experience
AU - Onaitis, Mark W.
AU - Noone, Robert B.
AU - Hartwig, Matthew
AU - Hurwitz, Herbert
AU - Morse, Michael
AU - Jowell, Paul
AU - McGrath, Kevin
AU - Lee, Catherine
AU - Anscher, Mitchell S.
AU - Clary, Bryan
AU - Mantyh, Christopher
AU - Pappas, Theodore N.
AU - Ludwig, Kirk
AU - Seigler, Hilliard F.
AU - Tyler, Douglas S.
N1 - Copyright:
Copyright 2007 Elsevier B.V., All rights reserved.
PY - 2001
Y1 - 2001
N2 - Objective: To examine clinical outcomes in patients receiving neoadjuvant chemoradiation for locally advanced rectal adenocarcinoma. Summary Background Data: Preoperative radiation therapy, either alone or in combination with 5-fluorouracil-based chemotherapy, has proven both safe and effective in the treatment of rectal cancer. However, data are lacking regarding which subgroups of patients benefit from the therapy in terms of decreased local recurrence and increased survival rates. Methods: A retrospective chart review was performed on 141 consecutive patients who received neoadjuvant chemoradiation (5fluorouracil ± cisplatin and 4,500-5,040 cgy) for biopsyproven locally advanced adenocarcinoma of the rectum. Surgery was performed 4 to 8 weeks after completion of chemoradiation. Standard statistical methods were used to analyze recurrence and survival. Results: Median follow-up was 27 months, and mean age was 59 years (range 28-81). Mean tumor distance from the anal verge was 6 cm (range 1-15). Of those staged before surgery with endorectal ultrasound or magnetic resonance imaging, 57% of stage II patients and 82% of stage III patients were downstaged. The chemotherapeutic regimens were well tolerated, and resections were performed on 140 patients. The percentage of sphincter-sparing procedures increased from 20% before 1996 to 76% after 1996. On pathologic analysis, 24% of specimens were TO. However, postoperative pathologic T stage had no effect on either recurrence or survival. Positive lymph node status predicted increased local recurrence and decreased survival. Conclusions: Neoadjuvant chemoradiation is safe, effective, and well tolerated. Postoperative lymph node status is the only independent predictor of recurrence and survival.
AB - Objective: To examine clinical outcomes in patients receiving neoadjuvant chemoradiation for locally advanced rectal adenocarcinoma. Summary Background Data: Preoperative radiation therapy, either alone or in combination with 5-fluorouracil-based chemotherapy, has proven both safe and effective in the treatment of rectal cancer. However, data are lacking regarding which subgroups of patients benefit from the therapy in terms of decreased local recurrence and increased survival rates. Methods: A retrospective chart review was performed on 141 consecutive patients who received neoadjuvant chemoradiation (5fluorouracil ± cisplatin and 4,500-5,040 cgy) for biopsyproven locally advanced adenocarcinoma of the rectum. Surgery was performed 4 to 8 weeks after completion of chemoradiation. Standard statistical methods were used to analyze recurrence and survival. Results: Median follow-up was 27 months, and mean age was 59 years (range 28-81). Mean tumor distance from the anal verge was 6 cm (range 1-15). Of those staged before surgery with endorectal ultrasound or magnetic resonance imaging, 57% of stage II patients and 82% of stage III patients were downstaged. The chemotherapeutic regimens were well tolerated, and resections were performed on 140 patients. The percentage of sphincter-sparing procedures increased from 20% before 1996 to 76% after 1996. On pathologic analysis, 24% of specimens were TO. However, postoperative pathologic T stage had no effect on either recurrence or survival. Positive lymph node status predicted increased local recurrence and decreased survival. Conclusions: Neoadjuvant chemoradiation is safe, effective, and well tolerated. Postoperative lymph node status is the only independent predictor of recurrence and survival.
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U2 - 10.1097/00000658-200106000-00007
DO - 10.1097/00000658-200106000-00007
M3 - Article
C2 - 11371736
AN - SCOPUS:0034980242
SN - 0003-4932
VL - 233
SP - 778
EP - 785
JO - Annals of surgery
JF - Annals of surgery
IS - 6
ER -