Prognostic implications of downstaging following preoperative radiation therapy for operable T3-T4 rectal cancer.

摘要: Abstract Purpose: To evaluate the prognostic value of tumor downstaging after preoperative radiation for resectable rectal cancer. Methods and Materials: Eighty-eight patients with non-metastatic cancers (76 T3 12 T4) were treated irradiation. Median dose was 40 Gy (30–46 Gy) delivered over 32 days (range 11–40). Seventeen received chemotherapy, two courses 5-fluorouracil (5FU) 350 mg/m2/day folinic acid 20 mg/m2/day; 5 per week during first fifth weeks radiotherapy. Surgery performed a mean delay 46 completion irradiation included 66 abdominoperineal resections 22 anal sphincter-preserving procedures. Postoperative chemotherapy administered in 44 patients. Results: Histological stages were: complete histological response 7%, pT2N0 19%, pT3N0 46%, pT2-3N1 28%. Tumor occurred 26%. No predictive factor statistically significant. The median follow-up 33 months. 3- 5-year cancer-specific survival rates 100% pT0N0 pT2N0, respectively, 89% 68% pT3N0, 64% 0% pT2T3N1. After irradiation, pathological remained factor. Patients (pT0T2N0) had significantly higher than group without downstaging: 80% at 3 years, 45% years; respectively (p = 0.011). recurrence free-survival 94% 56% 50%, 0.002). Conclusion: Downstaging this retrospective study results an improvement local control survival.