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HOME > J Korean Soc Coloproctol > Volume 20(3); 2004 > Article
Original Article
Clinical Results of Postoperative Chemoradiation on Advanced Rectal Cancers: Tumor Response, Toxicities, and Morbidity.
Lee, Dong Ryul , Lee, Han Il , Kim, Ho Gak , Kim, Eun Young , Ryoo, Hyun Mo , Yun, Sang Mo , Kim, Jin Cheon
Journal of the Korean Society of Coloproctology 2004;20(3):138-144

1Department of Surgery, Catholic University of Daegu School of Medicine, Daegu, Korea. hilee@cu.ac.kr
2Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea.
3Department of Radiation Oncology, Catholic University of Daegu School of Medicine, Daegu, Korea.
4Department of Surgery, University of Ulsan and Asan Medical Center, Seoul, Korea.
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Abstract

PURPOSE
Adjuvant chemotherapy and radiotherapy have been considered effective treatments in advanced rectal cancers. Recently, several studies have reported that preoperative chemoradiation (CRT) may have advantages over postoperative CRT, particularly in reducing local recurrence and preserving the anal sphincter. We studied the short-term efficacy of preoperative CRT for locally advanced rectal cancers.
METHODS
Between Jun. 2000 and Aug. 2003, 23 patients were treated with preoperative CRT, followed by surgery (pre-CRT) and 31 patients were treated with chemoradiation postoperatively (post-CRT). We compared these two groups for the incidence and degree of side effects from CRT, postoperative complications, type of surgery, including anal sphincter preservation, and short-term recurrence.
RESULTS
The average age and male-to-female ratio of the pre- and the post-CRT groups were 58+/-11, years and 13:10, and 61+/-14 and 14:17, respectively. T downstagings were observed in 17 of 23 (74%) pre-CRT patients. On the RTOG-EORTC scale, the patients who showed hematological, intestinal and dermal side effects in the pre-CRT group and in the post-CRT group were 5, 5, 2 and 5, 2, 4, respectively and the difference was not statistically significant (P=0.41). Anal sphincter preserving surgical procedures were performed 91.3% (21/23) and 83.9% (26/31) of the patients in the pre- and the post-CRT groups, respectively. But this difference was not statistically significant (P=0.4). Postoperative complications in the pre-CRT group were anastomosis site leakages (n=3) and rectovaginal fistula (n=1). In the post-CRT group, complications were two anastomosis site leakages. Four of the 31 post-CRT group patients had recurrences such as locoregional area (n=2), liver (n=1), and lung (n=1) while no patient was observed in pre- CRT group.
CONCLUSIONS
Although pre-CRT group showed higher incidence of complications than post-CRT group, these were managed easily and safely. Pre-CRT seems to be an effective modality for treating advanced rectal cancers particularly for preserving anal sphincter. Long-term follow- up data are needed to clarify the effect of pre-CRT.

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