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Tumor downstaging and sphincter preservation with preoperative chemoradiation in locally advanced rectal cancer: the M. D. Anderson Cancer Center experience.

Publication ,  Journal Article
Janjan, NA; Khoo, VS; Abbruzzese, J; Pazdur, R; Dubrow, R; Cleary, KR; Allen, PK; Lynch, PM; Glober, G; Wolff, R; Rich, TA; Skibber, J
Published in: Int J Radiat Oncol Biol Phys
July 15, 1999

PURPOSE: To evaluate the rates of tumor downstaging after preoperative chemoradiation for locally advanced rectal cancer. MATERIALS AND METHODS: Preoperative chemoradiotherapy (CTX/XRT) that delivered 45 Gy in 25 fractions over 5 weeks with continuous infusion 5-fluorouracil (300 mg/m2/day) was given to 117 patients. The pretreatment stage distribution, as determined by endorectal ultrasound (u), included uT2N0 in 2%, uT3N0 in 47%, uT3N1 in 49%, and uT4N0 in 2% of cases; endorectal ultrasound was not performed in 13% of cases (15 patients). Approximately 6 weeks after completion of CTX/XRT, surgery was performed. RESULTS: The pathological tumor stages were Tis-2N0 in 26%, T2N1 in 5%, T3N0 in 21%, T3N1 in 15%, T4N0 in 5%, and T4NI in 1%; a complete response (CR) to preoperative CTX/XRT was pathologically confirmed in 32 (27%) of patients. Tumor downstaging occurred in 72 (62%) cases. Only 3% of cases had pathologic evidence of progressive disease. Pretreatment tumor size (< 5 cm vs. > or = 5 cm) was the only factor predictive of tumor downstaging (p < 0.04). A decrease of > 1 T-stage level was accomplished in 45% of those downstaged. Overall, a sphincter-saving (SP) procedure was possible in 59% of patients and an abdominoperineal resection (APR) was required in 41 % of cases. Factors predictive of SP included downstaging (p < 0.03), age > 40 years (p < 0.007), pretreatment tumor distance, 3 to 6 cm from the anal verge (p < 0.00001), tumor size <6 cm (p < 0.02), mobility (p < 0.004), tumor stage 6 cm from the anal verge, SP was performed in 14 of the 15 (93%) patients with a CR and 32 of 33 (97%) of patients with residual disease (p < 0.00004). CONCLUSIONS: Significant tumor downstaging results from preoperative chemoradiation allowing sphincter sparing surgery in over 40% of patients whose tumors were located < 6 cm from the anal verge and who otherwise would have required colostomy.

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Published In

Int J Radiat Oncol Biol Phys

DOI

ISSN

0360-3016

Publication Date

July 15, 1999

Volume

44

Issue

5

Start / End Page

1027 / 1038

Location

United States

Related Subject Headings

  • Rectal Neoplasms
  • Radiotherapy Dosage
  • Oncology & Carcinogenesis
  • Neoplasm, Residual
  • Neoplasm Staging
  • Middle Aged
  • Male
  • Lymphatic Metastasis
  • Humans
  • Fluorouracil
 

Citation

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Janjan, N. A., Khoo, V. S., Abbruzzese, J., Pazdur, R., Dubrow, R., Cleary, K. R., … Skibber, J. (1999). Tumor downstaging and sphincter preservation with preoperative chemoradiation in locally advanced rectal cancer: the M. D. Anderson Cancer Center experience. Int J Radiat Oncol Biol Phys, 44(5), 1027–1038. https://doi.org/10.1016/s0360-3016(99)00099-1
Janjan, N. A., V. S. Khoo, J. Abbruzzese, R. Pazdur, R. Dubrow, K. R. Cleary, P. K. Allen, et al. “Tumor downstaging and sphincter preservation with preoperative chemoradiation in locally advanced rectal cancer: the M. D. Anderson Cancer Center experience.Int J Radiat Oncol Biol Phys 44, no. 5 (July 15, 1999): 1027–38. https://doi.org/10.1016/s0360-3016(99)00099-1.
Janjan NA, Khoo VS, Abbruzzese J, Pazdur R, Dubrow R, Cleary KR, et al. Tumor downstaging and sphincter preservation with preoperative chemoradiation in locally advanced rectal cancer: the M. D. Anderson Cancer Center experience. Int J Radiat Oncol Biol Phys. 1999 Jul 15;44(5):1027–38.
Janjan, N. A., et al. “Tumor downstaging and sphincter preservation with preoperative chemoradiation in locally advanced rectal cancer: the M. D. Anderson Cancer Center experience.Int J Radiat Oncol Biol Phys, vol. 44, no. 5, July 1999, pp. 1027–38. Pubmed, doi:10.1016/s0360-3016(99)00099-1.
Janjan NA, Khoo VS, Abbruzzese J, Pazdur R, Dubrow R, Cleary KR, Allen PK, Lynch PM, Glober G, Wolff R, Rich TA, Skibber J. Tumor downstaging and sphincter preservation with preoperative chemoradiation in locally advanced rectal cancer: the M. D. Anderson Cancer Center experience. Int J Radiat Oncol Biol Phys. 1999 Jul 15;44(5):1027–1038.
Journal cover image

Published In

Int J Radiat Oncol Biol Phys

DOI

ISSN

0360-3016

Publication Date

July 15, 1999

Volume

44

Issue

5

Start / End Page

1027 / 1038

Location

United States

Related Subject Headings

  • Rectal Neoplasms
  • Radiotherapy Dosage
  • Oncology & Carcinogenesis
  • Neoplasm, Residual
  • Neoplasm Staging
  • Middle Aged
  • Male
  • Lymphatic Metastasis
  • Humans
  • Fluorouracil