Resumen de Neoadjuvant chemotherapy and preoperative chemoradiotherapy in resectable carcinoma of the rectum

Ruth Vera García, Javier Arellano Aburto, Juan José Valerdi Álvarez, Martín Tejedor, Juan José Albistur Tomé, Juan Ignacio Arrarás Urdániz, Fernando Arias de la Vega

• The effectiveness of neoadjuvant chemotherapy (Mayo clinic schedule) and continuous oral chemotherapy (tegafur 400 mg and folinic acid 15 mg every 12 hours) administered during preoperative radiotherapy (4,500 cGy over 5 weeks) were studied in 53 patients with surgically-resectable rectal adenocarcinoma. Toxicities of <= grade II were lower with neoadjuvant chemotherapy while the chemoradiotherapy had higher toxicity rates including grade III diarrhoea (4%), grade III mucositis (4%), and grade III-IV neutropenia (9%). Symptom improvement ocurred in 38% of patients after neoadjuvant chemotherapy coparative with 55% following the first week of chemoradiotherapy. Surgery was curative in 97% of the patients: abdominoperineal amputation in 24 patients (47%) and conservative surgery in 28 (53%). Down-staging ocurred in 24 patients (46%), and 7 patients (14%) showed pathological complete response. Overvall survival at 5 years, with a median follow-up of 50 months, was 70% (cancer-specific survival was 75%) with significant differences recorded between N+ and N0 patients (56% and 76%, respectively; p<0.001), and between T-0-1-2 and T3 patients (73% and 56%, respectively; p<0.001). Only 2 patients (3%) had local relapse. In conclusion, this treatment scheme was well tolerated and had high rate of local control and long-term times.