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J Korean Soc Ther Radiol Oncol > Volume 27(2); 2009 > Article
The Journal of the Korean Society for Therapeutic Radiology and Oncology 2009;27(2): 78-83. doi: https://doi.org/10.3857/jkstro.2009.27.2.78
Effect of Suboptimal Chemotherapy on Preoperative Chemoradiation in Rectal Cancer
Jihye Lee, Hyun Cheol Kang, Eui Kyu Chie, Gyeong Hoon Kang, Jae Gahb Park, Do Youn Oh, Seock Ah Im, Tae You Kim, Yung Jue Bang, Sung Whan Ha
1Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea. ekchie93@snu.ac.kr
2Department of Pathology, Seoul National University College of Medicine, Seoul, Korea.
3Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
4Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
5Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea.
ABSTRACT
PURPOSE:
To examine the effect of suboptimal chemotherapy in patients undergoing preoperative chemoradiotherapy for the treatment of rectal cancer.
MATERIALS AND METHODS:
The medical records of 43 patients who received preoperative concurrent chemoradiotherapy, followed by radical surgery for the treatment of pathologically proven adenocarcinoma of the rectum from April 2003 to April 2006 were retrospectively reviewed. The delivered radiation dose ranged from 41.4 to 50.4 Gy. The standard group consisted of patients receiving two cycles of a 5-FU bolus injection for three days on the first and fifth week of radiotherapy or twice daily with capecitabine. The standard group included six patients for each regimen. The non-standard group consisted of patients receiving one cycle of 5-FU bolus injection for three days on the first week of radiotherapy. The non-standard group included 31 patients. Radical surgery was performed at a median of 58 days after the end of radiotherapy. A low anterior resection was performed in 36 patients, whereas an abdominoperineal resection was performed in 7 patients.
RESULTS:
No significant difference was observed between the groups with respect to pathologic responses ranging from grades 3 to 5 (83.3% vs. 67.7%, p=0.456), downstaging (75.0% vs. 67.7%, p=0.727), and a radial resection margin greater than 2 mm (66.7% vs. 83.9%, p=0.237). The sphincter-saving surgery rate in low-lying rectal cancers was lower in the non-standard group (100% vs. 75%, p=0.068). There was no grade 3 or higher toxicity observed in all patients.
CONCLUSION:
Considering that the sphincter-saving surgery rate in low-lying rectal cancer was marginally lower for patients treated with non-standard, suboptimal chemotherapy, and that toxicity higher than grade 2 was not observed in the both groups, suboptimal chemotherapy should be avoided in this setting.
Key Words: Rectal cancer, Preoperative, Chemoradiotherapy
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