P-0286 - Neo-Adjuvant Short Course Radiotherapy (The Tlalpan Regime) in a combined modality treatment for Locally Advanced Rectal Cancer with risk factors at...
|Date||28 June 2014|
|Event||World GI 2014|
|Topics|| Rectal Cancer
Surgery and/or Radiotherapy of Cancer
|Presenter||Jesus Zamora Moreno|
|Citation||Annals of Oncology (2014) 25 (suppl_2): ii14-ii104. 10.1093/annonc/mdu165|
G. Santiago Concha1, E. Mitsoura2, V. Aiello Crocifoglio3
In our country most patients who develop rectal cancer present with locoregionally advanced (T3 or node-positive) disease (LARC) and risk factors, as low rectum tumors, higher clinical stages and serum CEA elevated. Preoperative radiochemotherapy (RCT) with 5-Fu or capecitabine is the standard of care for these patients. Preoperative RCT achieves pathological complete response rates (pCR) of 10-15% generally in long course radiotherapy setting, with a lack of pCR in the short course regimes ≈ 1%. Recent literature suggests that patients experiencing a pCR have a better prognosis tan those with partial or no response (NpCR). With an aim to evaluate the pCR after a short regime of radiation therapy with chemotherapy in patients with LARC and risk factors a retrospective analysis was undertaken.
From January 2005 to December 2009, patients with locally advanced rectal cáncer were treated with preoperative concurrent chemoradiotherapy, consisting of 4500 cGy delivered in fractions of 300cGy per day, five days per week, in 3 weeks and fluoro-uracil or capecitabine concurrently. Patient data was retrospectively collected and analyzed in order to determine the treatment outcomes and identify prognostic factors for survival.
We identified 99 patients receiving the neoadjuvant approach, after 8 weeks of rest and a control endoscopy, 54 patients (54.54%) accepted the surgery proposed and 45 patients in a well being status rejected the surgical treatment, and are not part of this study. For the surgical group the median age was 52.50 years (range 18-82), Gender 27 female (50%%) and 27 male (50%), tumor size 6.75 cm (range 2-25 cm), distance from anal verge 4.05 cm (range 0-20 cm), Clinical Stage according to AJCC 2002 were CS I, 3 patients (5,6%), CS II, 10 patients (18.5%), CS III, 34 patients (63%), CS IV 7 patients (13%). The median CEA for the patients with pCR was 19.99 ng/ML(1-139), and for NpCR 31.50 ng/ML, the pCR was reached in 17 patients (31.48%), NpCR in 34 patients (62.96%) and 3 patients (5.55%) only a derivative colostomy was made. No toxicity grades III or IV was noted, with a median follow-up of 56 months (range 3-113), the median OS it is not reached for the pCR, and at the moment of this publication 58.8% of this patients are alive, for the NpCR was 45 months (CI 95% 45.68-69.58).
As a retrospective study it has several limitations, but based in our clinical data, this non-conventional treatment using a short course radiotherapy in a neo-adjuvant approach for LARC with risk factors, provides satisfactory pCR with an acceptable toxicity.