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

Objectives: The study analyzed and compared the long term outcome in locally advanced rectal cancer treatedwith preoperative and postoperative concurrent chemoradiation (CCRT). Materials and
Methods: A retrospectivereview of 105 patients with stage T3-T4 or regional lymph node positive adenocarcinoma of rectum treated withpreoperative or postoperative CCRT at Ramathibodi Hospital during 2005 to 2010 was performed. The results oftreatment 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 were87% 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 werediagnosed, 4 (11.8%) after preoperative CCRT and 3 (4.2%) after postoperative CCRT. The recurrent siteswere anastomosis in all patients. There was no significant factor associated with outcome after univariate andmultivariate testing. Grade 3 or 4 acute and late complications were low in both preoperative and postoperativeCCRT groups.
Conclusions: Locally advanced rectum cancer patients experience good results with surgery andadjuvant concurrent chemoradiation.