Prognostic factors for disease-free survival in patients with T3-4 or N+ rectal cancer treated with preoperative chemoradiation therapy, surgery, and intraoperative irradiation Journal Article
| Authors: | Díaz-González, J. A.; Calvo, F. A.; Cortes, J.; García-Sabrido, J. L.; Gómez-Espí, M.; Del Valle, E.; Muñoz-Jiménez, F.; Álvarez, E. |
| Article Title: | Prognostic factors for disease-free survival in patients with T3-4 or N+ rectal cancer treated with preoperative chemoradiation therapy, surgery, and intraoperative irradiation |
| Abstract: | Purpose: Fluoropyrimidine-radiosensitizing agents in conjunction with preoperative radiotherapy have proven to induce tumor and nodal downstaging effects, sphincter preservation promotion, and mid-term favorable survival rates. Intraoperative electron beam radiation therapy may improve pelvic control in patients with locally advanced rectal cancer stages. Potential predictive factors for response and disease-free survival, with intense local multidisciplinary approach, are analyzed. Methods and Materials: One hundred fifteen patients with rectal cancer were treated with oral 5-fluorouracil or Tegafur with preoperative radiotherapy, surgery, and intraoperative electron beam radiation therapy to identify potential pre- and on-treatment characteristics that might be of prognostic value for disease outcome. Univariate and multivariate analyses were performed. Results: Older patients and those treated with Tegafur were more likely to achieve a major histologic response, categorized as persistence of minimal residual microscopic disease foci in the surgical specimen ("mic" response). Factors unfavorably associated with disease-free survival in the multivariate model were male gender and persistence of macroscopic disease in the rectal wall ("mac" response). Accordingly, 3-year disease-free survival rates in the groups of patients with 0, 1, or 2 of these risk factors were 100%, 81%, and 53%, respectively (p < 0.001). Conclusions: Females with an intense pathologic response (pTmic residue) to preoperative chemoradiotherapy have an excellent 3-year disease-free survival. This information might be of interest for stratification of patients in the development of adjuvant treatment trials. © 2006 Elsevier Inc. |
| Keywords: | adult; cancer chemotherapy; cancer survival; aged; aged, 80 and over; disease-free survival; middle aged; cancer surgery; survival rate; major clinical study; fluorouracil; cancer risk; cancer patient; cancer radiotherapy; disease free survival; combined modality therapy; chemotherapy; neoplasm staging; adenocarcinoma; statistics; anemia; gastrointestinal symptom; antineoplastic combined chemotherapy protocols; radiotherapy dosage; drug administration schedule; radiotherapy; recurrence; risk factor; histology; drug fatality; electron therapy; disease severity; minimal residual disease; tumors; folinic acid; prognostic factors; surgery; multivariate analysis; dermatitis; sex factors; patient treatment; gender; univariate analysis; rectal neoplasms; rectum cancer; diseases; peroperative care; rectal cancer; intraoperative radiotherapy; tegafur; preoperative radiotherapy; rectum fistula; preoperative chemoradiation; electron beams |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 64 |
| Issue: | 4 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2006-03-15 |
| Start Page: | 1122 |
| End Page: | 1128 |
| Language: | English |
| DOI: | 10.1016/j.ijrobp.2005.09.020 |
| PUBMED: | 16406393 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 19" - "Export Date: 4 June 2012" - "CODEN: IOBPD" - "Source: Scopus" |
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