Comparison between preoperative and postoperative concurrent chemoradiotherapy for rectal cancer: an institutional analysis
We reviewed clinical records of 11 cases with preoperative chemoradiotherapy to evaluate the clinical effectiveness of chemoradiotherapy for T4 rectal cancer. The preoperative radiotherapy consisted of 40-50 Gy delivered in fractions of 1 .8- 2.0 Gy per day, five days per week. A treatment of 5-fluorouracil, 500 mg/body per day intravenously, or oral UFT-E (300 mg/m²) with l-leucovorin (75 mg) per day, or oral S-1 (80 mg/m²) per day five days per week, was given during radiotherapy. One patient died due to pelvic abscess in 63 days after chemoradiotherapy. Invasive findings to the adjacent organs identified by CT and MRI disappeared in 6 cases with complete or partial response 1 month after chemoradiotherapy. Curative surgery was performed in 7 patients. Although the adjacent organs were also removed during surgery in 7 patients, there was no histological invasion to the adjacent organs in 4 patients, and one patient had histological complete disappearance of tumor. Although complications after surgery were found in all of the patients, they were improved by conservative treatment. Two of 7 patients with curative surgery had recurrence, but the rest of them survived without recurrence. Preoperative chemoradiotherapy was expected to be an effective treatment to improve the resection rate and prognosis for T4 rectal cancer. However, it was thought that it was necessary to be careful about severe toxicity, such as pelvic abscess.