Preoperative Chemoradiation Therapy and Anal Sphincter Preservation with Locally Advanced Rectal Adenocarcinoma

被引：0

作者：

Pedro Luna-Pérez

Saúl Rodríguez-Ramírez

Darío F. Rodriguez-Coria

Armando Fernández

Sonia Labastida

Alejandro Silva

Marvin J. López

机构：

[1] Colorectal Service,

[2] Surgical Oncology Department,undefined

[3] Hospital de Oncología,undefined

[4] Centro Médico Nacional Siglo XXI,undefined

[5] Instituto Mexicano del Seguro Social,undefined

[6] Avenida Cuauhtémoc 330,undefined

[7] Colonia Doctores,undefined

[8] CP 06720 México,undefined

[9] D.F.,undefined

[10] México,undefined

[11] Radiotherapy Department,undefined

[12] Hospital de Oncología,undefined

[13] Centro Médico Nacional Siglo XXI,undefined

[14] Instituto Mexicano del Seguro Social,undefined

[15] Avenida Cuauhtémoc 330,undefined

[16] Colonia Doctores,undefined

[17] CP 06720 México,undefined

[18] D.F.,undefined

[19] México,undefined

[20] Statistical Section,undefined

[21] Hospital de Oncología,undefined

[22] Centro Médico Nacional Siglo XXI,undefined

[23] Instituto Mexicano del Seguro Social,undefined

[24] Avenida Cuauhtémoc 330,undefined

[25] Colonia Doctores,undefined

[26] CP 06720 México,undefined

[27] D.F.,undefined

[28] México,undefined

[29] Medical Oncology Department,undefined

[30] Hospital de Oncología Centro Médico Nacional Siglo XXI,undefined

[31] Instituto Mexicano del Seguro Social,undefined

[32] Avenida Cuauhtémoc 330,undefined

[33] Colonia Doctores,undefined

[34] CP 06720 México,undefined

[35] D.F.,undefined

[36] México,undefined

[37] Department of Surgery,undefined

[38] St. Elizabeth's Medical Center of Boston,undefined

[39] Tufts University School of Medicine,undefined

[40] 736 Cambridge Street,undefined

[41] CMP1,undefined

[42] Boston,undefined

[43] Massachusetts 02135,undefined

[44] USA,undefined

来源：

World Journal of Surgery | 2001年 / 25卷

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摘要：

Preoperative irradiation has been used to produce tumor regression and allow complete resection of rectal cancer with a sphincter-saving procedure. To evaluate the associated toxicity, the response in the primary tumor, and the postsurgical morbidity in a group of patients with locally advanced rectal cancer treated with preoperative chemoradiation therapy and low anterior resection, 120 patients were treated with 45 Gy of preoperative radiotherapy and a bolus infusion of 5-fluorouracil 450 mg/m2 on days 1 to 5 and 28 to 32 of radiotherapy. Four to six weeks later, 16 lesions were found unresectable; 36 patients underwent abdominoperineal resection or pelvic exenteration, and in the remaining 68 a low anterior resection was performed. For the purpose of this study only the latter group was included. There were 38 men and 30 women, with a mean age of 54.7 ± 13.1 years. Gastrointestinal and hematologic acute toxicity grade 3 to 4 occurred in 12 and 7 patients, respectively. The mean distance of the tumor above the anal verge was 8.2 ± 2.6 cm. In 10 patients the surgical resection included neighboring pelvic organs; 16 patients (23.5%) required a temporary diverting colostomy. The main causes of surgical morbidity were clinical anastomotic leakage in seven (10%), abdominal wall infection in five (7.4%), anastomotic stenosis in three (4.5%), and intraabdominal abscess in one (1.5%). No operative deaths occurred. The postsurgical stages were as follows: no tumor in the specimen, 17 (25%); T1, 4 (6%); T2, 12 (17%); T3, 17 (25%); T4, 5 (7%); any T with N+, 9 (13%); and any T, N with M+, 4 (6%). The median and mean follow-ups were 30.0 months and 37.4 ± 25.0 months, respectively. The local recurrence rate was 2.9%, and the distant recurrence rate was 17%. The administration of preoperative chemoradiation therapy for locally advanced rectal cancer is associated with tolerable toxicity, a high rate of response in the primary tumor that allowed anal sphincter preservation, and a low rate of local recurrence.

引用

页码：1006 / 1011

页数：5