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Oncologic Outcomes After Neoadjuvant Chemoradiation Followed by Curative Resection With Tumor-Specific Mesorectal Excision for Fixed Locally Advanced Rectal Cancer: Impact of Postirradiated Pathologic Downstaging on Local Recurrence and Survival

 Nam Kyu Kim  ;  Seung Hyuk Baik  ;  Jin Sil Seong  ;  Hoguen Kim  ;  Jae Kyung Roh  ;  Kang Young Lee  ;  Seung Kook Sohn  ;  Chang Hwan Cho 
 ANNALS OF SURGERY, Vol.244(6) : 1024-1030, 2006 
Journal Title
Issue Date
Adult ; Aged ; Aged, 80 and over ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Neoadjuvant Therapy* ; Neoplasm Recurrence, Local/mortality ; Neoplasm Recurrence, Local/pathology* ; Neoplasm Staging ; Rectal Neoplasms/mortality ; Rectal Neoplasms/pathology* ; Rectal Neoplasms/therapy* ; Retrospective Studies ; Survival Rate ; Treatment Outcome
OBJECTIVE: The purpose of this study was to determine the oncologic outcomes and clinical factors affecting survival in patients who underwent neoadjuvant chemoradiotherapy following tumor specific mesorectal excision for locally advanced, fixed rectal cancer.
SUMMARY BACKGROUND DATA: Neoadjuvant chemoradiation therapy has resulted in significant tumor downstaging, which enhances curative resection and subsequently improves local disease control for rectal cancer. However, oncologic outcomes, according to clinical factors, have not yet been fully understood in locally advanced and fixed rectal cancer.
METHODS: A total of 114 patients who had undergone neoadjuvant chemoradiation for advanced rectal cancer (T3 or T4 and node positive) were investigated retrospectively. Chemotherapy was administered intravenously with 5-FU and leucovorin during weeks 1 and 5 of radiotherapy. The total radiation dose was 5040 cGY in 25 fractions delivered over 5 weeks. Tumor-specific mesorectal excision was done 4 to 6 weeks after the completion of neoadjuvant chemoradiation. Survival and recurrence rates, according to the pathologic stage, were evaluated. Moreover, factors affecting survival were investigated.
RESULTS: The 5-year survival rates according to pathologic stage were: 100% in pathologic complete remission (n = 10), 80% in stage I (n = 23), 56.8% in stage II (n = 34), and 42.3% in stage III (n = 47) (P = 0.0000). Local, systemic, and combined recurrence rates were 11.4%, 22.8%, and 3.5%, respectively. Multivariate analysis showed that the pathologic N stage and operation method were the independent factors affecting survival rate.
CONCLUSION: Pathologic complete remission showed excellent oncologic outcomes, and the pathologic N stage was the most important factor for oncologic outcomes.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Nam Kyu(김남규) ORCID logo https://orcid.org/0000-0003-0639-5632
Kim, Hogeun(김호근)
Roh, Jae Kyung(노재경)
Baik, Seung Hyuk(백승혁) ORCID logo https://orcid.org/0000-0003-4183-2332
Seong, Jin Sil(성진실) ORCID logo https://orcid.org/0000-0003-1794-5951
Sohn, Seung Kook(손승국)
Lee, Kang Young(이강영)
Cho, Chang Hwan(조장환)
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