Volume : 8, Issue : 3, March - 2019

NEOADJUVANT CHEMORADIOTHERAPY FOR LOCALLY ADVANCED OPERABLE RECTAL CANCER -IS THERE A ROLE? STUDY FROM A TERTIARY CARE CENTRE

Dr. Manjunath. K. V, Dr. Veerendra Kumar. K. V, Dr. Durgesh, Dr. Ravi Arjunan, Dr. Syed Althaf

Abstract :

AIM: This study evaluates the potential benefits and outcome following neoadjuvant chemoradiotherapy for locally advanced operable rectal cancer. Primary end points analyzed are the downsizing of tumor, downstaging of the tumor, sphincter saving rates, toxicity of chemoradiotherapy, patient compliance for the regimen. Secondary end points analyzed are the incidence of local recurrence, distant metastasis. The incidence of perioperative complications and postoperative complications are also analyzed MATERIAL AND METHODS: Retrospective study was conducted in the Department of Surgical oncology, Kidwai memorial institute of oncology from March 2010 to November 2014 RESULTS: Patients age ranged from 22-51 yrs, mean age being 43.6 years. Thirty-one males and thirty were females in our study. Most of the tumours extended into anal canal (63 %). Thirty-nine patients had stage 3 B disease and nine had stage 3 a disease. Fifty one percent of patients had moderately differentiated carcinoma and thirty eight percent had well differentiated tumors. The interval from chemo radiotherapy to surgery ranged from six to nine weeks. The surgeries performed ranged from anterior resection, with concomitant hysterectomy in females to abdominoperineal excision of rectum. APR intended Sphincter saving planned for 54 patients but was only in 13/54 (24 %) Before neoadjuvant chemoradiotherapy only six anterior resections were planned. After it, fifteen anterior resections were done. Anterior resections intended Anterior resections done 6(12.5 %) but 15 (31.5 % ) had anterior resection (P = 0.001).Neoadjuvant chemoradiotherapy increased sphincter conservation from 12.5% to 31.5%. CONCLUSION: Neoadjuvant chemoradiotherapy given in operable locally advanced mid and low rectal cancers causes significant downsizing, downstaging of the tumour, increases the rate of sphincter conservation surgeries. The toxicity of chemoradiotherapy is minimal, patient compliance is good. The postoperative complications are not increased, and it helps decrease the incidence of local recurrence. The effect on survival has to be determined on long term follow up only. Hence it is beneficial to administer it to patients with locally advanced operable mid and low rectal cancers.