P-344 - Long-term outcomes after combined chemoradiation therapy of locally advanced rectal cancer, complicated by fistula formation

Date 04 July 2015
Event WorldGI 2015
Session Posters
Topics Anti-Cancer Agents & Biologic Therapy
Complications of Treatment
Rectal Cancer
Surgery and/or Radiotherapy of Cancer
Presenter O. Kolesnik
Citation Annals of Oncology (2015) 26 (suppl_4): 1-100. 10.1093/annonc/mdv233
Authors O. Kolesnik, A. Lukashenko, D. Makhmudov
  • National Cancer Institute, Kiev/UA

Abstract

Introduction

Locally advanced rectal (LARC) cancer with invasion to adjacent organs is usually detected in 5 – 22% of primary patients. Rectovesical, rectovaginal and external fistulas are present in 7-9% of these patients. Neoadjuvant chemoradiation therapy (NCRT) might cause a great benefit for tumor downstaging, downsizing and disease-free survival, but vast majority of cases presence of a fistula remains a contraindication for such procedure. The role of NCRT in cases of LARC with fistula formation isn't developed, leaving many actual questions unsolved

Methods

Thirty two patients, who underwent curative treatment for ypT4N0-1M0 LARC, complicated by formation of malignant external, rectovaginal or rectovesical fistulas from 2000 until 2012 were included. All patients underwent NCRT of total 30 – 60Gy additionally with either Capecitabine alone or FOLFOX-6/CapOX regimen 2 – 5 courses prior to curative surgery. Response to NCRT, overall and recurrence-free 5-year survival rates and local recurrence rates were assessed

Results

Lower rectum was the most frequent primary tumor site – 18 (56%). Rectovaginal fistulas were present in 25 patients (78%), rectovesical – 4 (12.5%), external – 3 (9.5%). Abdomino-perineal excision was performed in 63% of patients. A total radiation dose of 30Gy was administered to 13 patients (40%), 19 received a total dose of 50 – 60Gy. No specific complications, related to proceeding of radiation therapy or rather chemotherapy were observed. Complete response to NCRT with fistula healing was observed in 2 cases (6.25%), partial response – 9 (27%), stabilization – 21 (66.75%). No cases of tumor progression after NCRT were observed. During the study period 2 (6%) cases of local recurrence were observed. Overall 5-year survival was 45 ± 12,3%. Overall 5-year recurrence-free survival rate was 34 ± 11,4%

Conclusion

NCRT is eligible and justified for patients with LARC, complicated by fistula formation. No cases of specific radiation therapy-related complications were observed. Providing tumor downstaging and downsizing carries a benefit of increasing a rate of resectability on the one hand, and decreasing local recurrence rate on the other. NCRT should be applied as a treatment option for patients with LARC, complicated by fistula formation