Preoperative chemoradiation for rectal cancer: results of multimodality management and analysis of prognostic factors

Background: Our goals were to examine the impact of neoadjuvant chemoradiation for rectal cancer on surgical outcomes and to determine prognostic factors predicting improved survival. Methods: Retrospective cohort of 56 male and 44 female patients. Results: After preoperative chemoradiation, 73% of patients had sphincter-preserving surgery. The 5-year disease-free (DFS) and overall survival rates were 77% and 81%, respectively. Twenty-five percent of patients showed a complete pathologic response. T-level downstaging and pathologic T stage did not correlate with recurrence or survival rates. Pathologic nodal stage was associated with a significant difference in recurrence rates (N-0 19%, N-1 20%, and N-2 75%, P = .038) and DFS (N-0/N-1 vs. N-2, 79% vs. 25%, P = .002). Conclusion: Neoadjuvant chemoradiation resulted in a high rate of sphincter preservation. Complete pathologic responses after surgery were frequent and although pathologic T stage after surgery did not affect recurrence rates, pathologic nodal response was associated with improved recurrence and survival rates. (c) 2007 Excerpta Medica Inc. All rights reserved.