Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront Surgery?

Abstract

Purpose: Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery. 1.2. Methods and materials: In this retrospective study we enrolled patients with upper rectal or sigmoid junction locally advanced tumors (stages II-III). At the first Institution patients received NCRT followed by surgery (study group); at the second Institution patients were referred to upfront surgery (control group). Overall survival was the main endpoint of the analysis. Local relapse and other clinical variables were also analyzed. 1.3. Results: Fifty patients in the study group and 32 patients in the control group were analyzed. In the NCRT group there were more N-positive patients (p<0.001); T-stage was similar for both groups. All surgical procedures were performed with R0 margins. Among NCRT patients, in seven cases (14%) complete pathologic response was found. In 27 cases (54%) downstaging in T-stage was achieved. Comparing OS between NCRT and control group there was no significant difference at five years: 84% for NCRT group and 79% for control group (p 0.37). In univariate analysis, clinical T-stage had a statistically significant impact on survival. Patients with cT3 disease did better than patients with cT4 (p = 0.014). Two cases of G4 toxicity were observed and only one case of local relapse was observed in NCRT group. 1.4. Conclusion: NCRT achieved a high rate of downstaging alongside tolerable toxicity profile, but did not affect survival outcome in this selected group, as compared to surgery alone.