Safety And Efficacy Of Preoperative Chemoradiotherapy In Patients With Stage Ⅱ To Ⅲ And Located Above Peritoneal Rectal Cancer

Objective To investigate the safety and efficacy of preoperative chemoradiotherapy in patients with stage II to III and located above peritoneal rectal cancer.Materials and Method From Januely 09,2013 to December 31,2014,512 locally advanced rectal cancer(LARC)patients initially treated in our department were screened out and analyzed who meet the following conditions:(1)MRI examination before initial treatment showed that the tumor location had a distance at least 7cm from the anal margin(above the peritoneal reflection).If there was no information of the tumor location on MRI imaging,transrectal ultrasound examination was used as the criterion.If neither of them was found,distance from the lower edge of the tumor to the anus by colonoscopy was choosen as a standard;(2)Clinical stages T3/4 and/or N+ was classified by the seventh American Joint Committee on Cancer staging;(3)The pathological type was adenocarcinoma.All eligible patients received radiotherapy and chemotherapy before operation,and then received total mesorectal excision.The Kaplan-Meier method was used to calculate the survival of patients at 3,5 years after treatment,and related factors affecting the survival of patients with rectal cancer were analyzed by a multivariate Cox proportional hazard regression model.P <0.05 was considered significantly.Results A total of 111 rectal cancer patients whose tumor located above peritoneal reflection were enrolled,and 28 patients of them were excluded,including 3patients with metastasis and no surgery,7 patients with metastasis,3 patients only receiving radiotherapy,13 patients with no surgery,and 2 patients with incomplete information.83 patients were included retrospective analysis finally.The average age of patients was 55 years±1.1,including 53 males and 30 females,with the male to female ratio of 1.8: 1.The lower boundary of the tumor was ≥7cm and <10cm from the anal margin and ≥10cm from the anal margin were 63 cases(75.9%)and20 cases(24.1%)respectively.Only two patient(2.4%)was staged II rectal cancer,and the remaining 81 patients(97.6%)were staged III rectal cancer.There was no ≥grade 3 acute toxicity of skin,mucous membrane,upper gastrointestinal tract and urinary system,and only 2(2.4%)patients had grade 3 lower gastrointestinal reaction,and only 4(4.8%)patients had ≥ grade 3 leukopenia.There was only one case of severe liver dysfunction,and liver function improved after treatment.Surgery was performed 6-12 weeks after chemoradiotherapy.1 case of anastomotic fistula and 3 cases of intestinal obstruction appeared.No incision infection and anastomotic bleeding occurred.Postoperative pathological complete response(p CR)rate was 12.0%,the 5-year overall survival(5-year OS)was 84.3%,and the 5-year disease-free survival(5-year DFS)was 80.7%.By multivariate Cox proportional hazard regression model analysing prossible related prognostic factors,such as age,tumor location,clinical T stage,CEA level at initial diagnosis and rectal cancer regression grade(RCRG),it was concluded that CEA ≤ 5ng / ml at initial diagnosis and the lower margin of the tumor from the anus ≥7cm and < 10 cm were an independent favorable factor affecting the prognosis of patients with locally advanced rectal cancer above the peritoneal reflection(P = 0.007 and P=0.020).Conclusion According to our data,preoperative chemoradiotherapy is a safe and effective treatment for locally advanced rectal cancer above peritoneal reflection.