| Objective:To explore the effectiveness, toxicity and failure patterns for patients with locally advanced lower or middle rectal adenocarcinoma after combination of pre-operative radiation and concurrent oxaliplatin plus capecitabine.Methods:Patients with rectal adenocarcinoma and clinical stage Ⅱ/Ⅲ were enrolled in a prospective phase Ⅱ clinical trial at2006-2012years. One hundred and eighty-six patients received pre-operative chemoradiation (pre-CRT), which consisted of44-50.4Gy in22-28fractions with concurrent chemotherapy of oral capecitabine1650mg/m2/d in bid from d1-35and oxaliplatin50mg/m2per week for5times. Radical surgery was performed4-8weeks after chemoradiotherapy. Survival rates and prognostic factors were estimated by Kaplan-Meier method and multivariate analysis, failure patterns were also evaluated.Results:One hundred and thirty-seven patients with clinical stage Ⅱ (n=34) and the other were stage Ⅲ disease (n=103) underwent radical resection. The lower (the anal distance≤5cm) and middle (the anal distance5-10cm) located lesions were102(74.5%) and35(25.5%), respectively. Diarrhea was the most frequent acute Grade3toxicity, which was observed in29patients (21.2%).69patients (50.4%) were downstaged,21patients (15.3%) achieved complete regression of primary lesion,20(14.6%) were defined as pathological complete response (ypTON0), With a median follow-up of22.2months, disease failure were detected in37patients, including local/regional recurrence (LRR)(n=2), LRR and distant metastasis (DM)(n=7), DM (n=28). The2-year overall survival (OS), locoregional recurrence free survival (LRFS) and disease free survival (DFS) of all patients were92.4%,93.1%and71.0%, respectively. In multivariate analysis, pathological stage of yp0-Ⅱ was identified as independent factor related to OS and DFS.Conclusion:Preoperative concurrent chemoradiotherapy with oxaliplatin and capecitabine for locally advanced lower or middle located rectal cancer achieved excellent2-year locoregional control. The pathological stage of yp0-Ⅱ was correlated with the favorable survival. Objective:To explore the value of apparent diffusion coefficient (ADC) in predicting the effect of preoperative chemoradiation (pre-CRT) for locally advanced rectal cancer.Methods and Materials:Patients with histopathologically proven, clinical stage II/III rectal cancer were enrolled prospectively at2007-2011years. Patients received pre-CRT,44-50.4Gy/22-28fractions was delivered to the pelvis. Concurrent chemotherapy was composed of capecitabine (1650mg/m2/d in bid d1-35) and, oxaliplatin (50mg/m2weekly×5times), subsequent surgery was performed4-8weeks after CRT. Diffusion weighted imaging (DWI) were performed in all patients before CRT, some patients underwent during and/or post CRT DWI examination. The differences of ADCs between groups were evaluated by nonparametric Mann-Whitney U test. Survivals were analyzed by the Kaplan-Meier method and compared by log-rank test.Results:Seventy patients were enrolled. Ten (10%) patients achieved pCR and38patients (54.3%) were downstaged. With a median follow-up of34months,22(31.4%) patients experienced recurrence. The3-year overall survival, locoregional-free survival, disease-free survival and distant metastasis-free survival were83.8%,88.3%,68.4%and71.3%, respectively. The mean pre-ADC, during-ADC, post-ADC were1.09±0.19×10-3,1.28±0.19×10-3and1.47±0.24×10-3mm2/s, respectively. The mean pre-ADCs in favorable groups (pCR, downstaging, non-progress) were significantly lower than those of the unfavorable groups (p<0.05). When a pre-ADC value of1.06×10-3mm2/s was used as the cut-off for predicting downstaging, the area under the receiver operator characteristic curve was0.737(95%CI:0.618-0.856). The3-year DFS and DMFS of patients with pre-ADC<1.06×10-3mm2/s was85.9%and90.0%, which were significantly higher than the patients with pre-ADC≥1.06x10"3mm2/s,57.5%and59.8%(P=0.01and P=0.01).Conclusion:The ADC in locally advanced rectal cancer correlates to the result of pre-CRT and has the potential to predict therapeutic effect of preoperative chemoradiotherapy for rectal cancer. Objective:To evaluate the long-term survival and treatment failure patterns for patients with lower-sited stage I rectal adenocarcinoma after local excision with or without adjuvant radiotherapy.Material and methods:From Jan,2000to Dec,2008, Seventy-seven patients were received local excision, while41received local excision with adjuvant radiation.54patients were pathologically proven as T1, the other23as T2. Survival rates and univariate prognostic factors were estimated by Kaplan-Meier method, and comparisons were made by the log-rank test.Results:40patients were followed up more than5years. Similar5-year local recurrence-free survival and overall-survival rates could be achieved for low risk patients if compared local excision with surgery followed by adjuvant radiotherapy (86%vs.83%, P=0.588and100%vs.100%, P=0.221). In high risk patients,5-year local recurrence-free survival were similar (80%vs.82%, P=0.6), but the overall-survival were significantly different (92%vs.66%, P=0.031). The5-year local recurrence-free survival and overall survival (OS) rate were83%and82%respectively. By univariate analysis, size of the lesion, positive margin, poor differentiation, the distance from the tumor to anal verge and pT2stage were negative prognostic factors for OS. Overall recurrence rate in whole group was29%, and70%of them were local relapse. The5-year OS of patients received radical salvage surgery after local relapse was69%.Conclusions:For stage I lower-sited rectal cancer., patients with low risks can get good result after local excision alone. The role of adjuvant radiation in high risk patients needs further evaluation. Local relapse is the main cause of failure, and salvage surgery after local relapse can achieve long-term survival. |
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