Authors: Wafaa A. Elnemrawy, Hany M. Abd Elaziz, Ramy R. Ghali, Nesreen A. Mosalam.
Background: The treatment of locally advanced rectal cancer (LARC) is subject to continuous change due to better diagnostic tools, radio therapeutic techniques and chemotherapeutic agents. Careful consideration of primary tumor, regional lymph node and distance metastasis will improve the survival of rectal cancer with the selection of proper therapy. Widespread use of neoadjuvant therapy has all contributed to decrease the rate of local recurrence, raise the quality of life and the probability of overall survival.
Aim of the Work: to correlate clinico-epdemiological factors of LARC patients receiving neoadjuvant concurrent chemo radiotherapy (NACRT) with disease -free survival (DFS) and overall survival (OS).
Patients and Methods: In this retrospective study, data collected from files of 100 patients with LARC assessed using colonoscopy, enhanced computed tomography, and or magnetic resonance imaging, between Jan 2010 and December 2016 in oncology department of Ain Shams faculty of medicine and Nasser institute of treatment and research. The patients received long course radiotherapy (45-50.4 Gy/1.8-2 Gy) combined with concurrent chemotherapy. Surgery was done after NACRT, which had been abdominoperineal resection (APR), low anterior
resection (LAR), exploration. Data collected retrospectively by reviewing of medical records (hard copy records, pre-treatment radiology, radiotherapy documentation, surgical and pathology reports, and follow up clinic records). Ethics committee of Ain Shams faculty of medicine approved the study.
Results: This study showed younger age presentation of our population with median age 44yr. Median of locoregional recurrence free survival of the study group is18ms with 95 %CI. Median of distant metastasis free survival of the study group is 15ms ± 3.45 with 95% CI. Median DFS of study group was 12ms with 95% CI. Median overall survival of study group was 48ms with 95% CI while 5-year OS not reached. The study showed that grades of rectal cancer having statistically difference with DFS and OS with P value 0.009 and hazard ratio 1.919 with 95% CI. Types of surgery (LAR, APR and exploration) had statistically significant difference and impact on DFS and OS with P value 0.044 and hazard ratio 1.646 with 95% CI. y-pathological nodal staging had statistically significant difference on DFS and OS with P value 0.042 and hazard ratio 1.633 with 95% CI. Pathological response that achieved after CCRT having statistically significant difference on DFS and OS with P value 0.048 and hazard ratio 1.323 with 95%CI.
Conclusion: Assessment of LARC patients before selection type of therapy is very critical to select whom patient will gain functional preservation at the time of surgery and increase probability of overall survival. The study showed younger age presentation of our population with median age 44yr that may refers indirectly to more clinico-epidemiological difference than other population. Therefore, it is critical to undergo further studies in these specific age groups.
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