Modulation ofpreoperative chemoradiation can reduce the requirement for abdomino-perineal resection in low rectal cancer patients: OP51


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Abstract

Aim:To evaluate the clinical factorspredictive of abdominoperineal resection (APR) in low rectal cancer in patients treated bypreoperative chemoradiotherapy (preopCRT)Method:Our inclusion criteria were: rectal cancer up to 7 cm from anal verge (AV);preop CRT; surgery: APR versus any sphincter savingprocedures. The variables considered were: age, gender, distance tumour to anal verge, clinical TNM, RT dose; 5FU infusion modality, drugs associated to 5FU, time RT-surgery; and also the treatment periods: (1) 1994-1999; (2) 2000-2004; (3) 2005-3/2010. Univariate and multivariate statistical analysis were carried out.Results:Two hundred and five patients (age:61 [20-84] years, 68 female), level of tumour: 5 (1-7) cm; T stage cT2, T3, T4, not available (na): 22, 114, 61, 8; stage N+ (136 patients) were treated with RT (50.40 [40-60] Gy) and operated at an interval of 49 (9-176) days were treated in periods 1, 2, 3 as follows: 51; 75, 79. FU was given as infusion, bolus, cvi, or with capecitabine as follows: 53,111,19,22. Drug combinations were as follows: FU; FU+oxaliplatin, FU+leucovorin, FU+ other, na: 95, 40, 35, 21, 14. APR was carried out in 42 patients. Univariate analysis: showed the risk of APR to be reduced by level of tumour (P < 0.001), stage cT3 (P < 0.001), FU cvi (P = 0.040), two drug combination (P = 0.06); increasing interval to surgery (P = 0.0095), RT dose (P = 0.052). Multivariate analysis showed the risk of APR to be reduced by level of tumour, stage cT3, FU cvi (P < 0.001) and delayed surgery (P = 0.005).Conclusion:Preoperative therapy can be modulated with the aim of APR reduction.

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