Treatment of rectal cancer by chemoradiation followed by surgery: analysis and early clinical outcome in 66 patients.

BACKGROUND Abdominoperineal resection entails the need for a permanent colostomy, which significantly reduces patient self-image and quality of life. OBJECTIVE To investigate the effectiveness of preoperative chemoradiation in increasing the resectability rates of rectal cancer and increasing the anal sphincter preservation rate. METHODS The study group included 66 patients aged 33-84 years with T2-T3 rectal carcinoma who were treated in our institute from 1997 to 2002 with preoperative chemoradiation followed by surgery 6 weeks later. All patients underwent preoperative transrectal endoscopic ultrasound for tumor staging and localization. The duration of follow-up was 25 months. RESULTS Chemoradiation led to tumor downstaging in 61 patients (92.4%), all of whom underwent low anterior resection. Only 11.4% of this group needed a temporary (6 weeks) loop colostomy/ileostomy. None of the 16 patients with post-treatment T0 tumors had evidence of malignant cells on pathologic study. Five patients (7.6%) failed to respond to chemoradiation and underwent APR. There were no major complications, such as leakage, and no deaths. CONCLUSIONS Neoadjuvant chemoradiation is an effective modality to downstage advanced rectal cancer, improving patient quality of life by significantly reducing the need for a terminal permanent colostomy, or even a temporary one.