637 - Neoadjuvant treatment in rectal cancer: national institute of cancer from Brazil experience

Date 28 September 2012
Event ESMO Congress 2012
Session Publication Only
Topics Anticancer agents
Surgical oncology
Colon and Rectal Cancer
Therapy
Biological therapy
Radiation oncology
Presenter luciana Aquino
Authors L.C.M. Aquino1, M.S. Rossi1, P.C. Val1, M.A. Oliveira1, T. Matta-Castro1, D. Herchenhorn2, C.G. Duque1, R.D.A. Gil1, B.S.V. Pereira1
  • 1Oncology, Instituto Nacional de Câncer, 20230000 - rio de janeiro/BR
  • 2Medical Oncology, Brazilian National Cancer Institute, Rio de Janeiro/BR

Abstract

Background

Neoadjuvant chemoradiotherapy is associated with tumor downstaging, higher rate of pathologic complete response (pCR), and increased tumor resectability. The aim of the present study was to determine the outcome of patients with rectal cancer that underwent multimodality treatment in a reference institution.

Methods

Retrospective analysis of the medical charts of patients with rectal cancer at National Institute of Cancer from Brazil, between 2001 and 2008. Data from 522 patients were collected using a standardize procedure. The Kaplan-Meier method and log-rank test were used.

Results

From a total of 522 patients identified, 380 patients (72.8%) underwent neoadjuvant chemoradiotherapy, and were the subject of our analysis. The regimen consisted of radiotherapy (RT) 50,4 Gy and 5FU-based chemotherapy during the first and fifth week of RT. The median age was 58 years and 55.8% was male. The median preoperative CEA was 4.4. Most of the tumors (55,8%) were located in the lower rectum. Median time between completion of neoadjuvant therapy and surgery was 97 days. 51.5% and 23.6% underwent anterior resection and abdomino-perineal resection, respectively. Fourteen percent of patients did not undergo surgery, among these, 22% had metastatic disease. The most common ypTNM staging was IIA (26,8%). The rate of pathologic complete response (pCR) was 7.7%. Metastatic disease was identified during surgery in 14,5% of patients. Among patients who underwent surgery after neoadjuvant therapy, 39% received adjuvant chemotherapy, QUASAR was the regimen of choice in 60,8%. Median time between surgery and adjuvant therapy was 69 days. With a median follow up of 52 months, 41,8% of patients who did neoadjuvant treatment had progression disease. Overall survival at 5 years was 96% for stage I, 75.5% for stage II, 53.6% for stage III and 15.9% for stage IV. The overall survival at 5 years for those who reached the pCR and those that did not was 91.6% and 61.4% respectively (p = 0.042).

Conclusion

Despite lower rate of pCR and the long time between the neoadjuvant treatment and surgery, survival was similar with previous reports. More intensive chemotherapy protocols are in investigation to improve pathological response rates.

Disclosure

All authors have declared no conflicts of interest.