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CC BY-NC-ND 4.0 · Journal of Coloproctology 2023; 43(03): e208-e214
DOI: 10.1055/s-0043-1773782
Original Article

Evaluation of the Response Rate to Neoadjuvant Chemoradiotherapy in Patients with Rectal Adenocarcinoma: A Retrospective Long-term Study in Two Terciary Reference Centers

Juliana Lima Toledo Rossoni 
1   Department of Surgery & Anatomy, University of São Paulo, Hospital das Clínicas, Faculty of Medicine of Ribeirão Preto, Ribeirão Preto, São Paulo, SP, Brazil
,
Marley Ribeiro Feitosa
2   Department of Surgery & Anatomy, Division of Coloproctology, University of São Paulo, Faculty of Medicine of Ribeirão Preto, São Paulo, SP, Brazil
,
Caio Vinícius Souza Tosetti
3   Department of Surgery & Anatomy, University of São Paulo, Hospital das Clínicas, Faculty of Medicine of Ribeirão Preto, São Paulo, SP, Brazil
,
Omar Feres
4   Department of Surgery & Anatomy, Division of Coloproctology, University of São Paulo, Hospital das Clínicas, Faculty of Medicine in Ribeirão Preto, São Paulo, SP, Brazil
,
José Joaquim Ribeiro da Rocha
2   Department of Surgery & Anatomy, Division of Coloproctology, University of São Paulo, Faculty of Medicine of Ribeirão Preto, São Paulo, SP, Brazil
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Abstract

Objectives To evaluate the complete response (CR) rate and surgeries performed in patients with rectal adenocarcinoma who underwent neoadjuvant therapy (NT) at Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo and at Hospital São Paulo, in Ribeirão Preto, from January 2007 to December 2017.

Methods We evaluated 166 medical records of patients with locally advanced rectal adenocarcinoma (T3, T4 or N + ) who underwent NT. The regimen consisted of performing conventional (2D) or conformational (three-dimensional-3D/ radiotherapy with modulated intensity – IMRT) at a dose of 45-50.4Gy associated with capecitabine 1650mg/m2 or 5-fluorouracil (5FU) and leucovorin (LV). The following variables were analyzed: gender, age, pretreatment stage, radiotherapy, CR index, local and distant recurrence rates. Surgical treatment and complications were also evaluated.

Results The CR index was 28.3%. Patients treated with 3D/IMRT radiotherapy had a higher rate of CR (36.3% x 4.8%; p < 0.001), higher rates of clinical follow-up (21% x 0%; p < 0.001), lower surgery rates (79% x 100%; p < 0.001), higher rates of transanal resection (37.1% x 9.5%; p = 0.001), lower rates of abdominal rectosigmoidectomy (25.8% x 50%; p = 0.007) and lower rates of abdominoperineal resection of the rectum (16.1% x 40.5%; p = 0.002), when compared to patients treated with 2D radiotherapy.

Conclusion Modern radiotherapy techniques such as 3D conformal and IMRT, by offering greater adequacy and precision of treatment, could result in better local control and less toxicity in organs at risk, enabling organ preservation strategies and less invasive approaches in selected cases.

Keywords

rectal cancer - neoadjuvant therapy - radiotherapy


Publication History

Received: 18 June 2023

Accepted: 14 August 2023

Article published online:
21 September 2023

© 2023. Sociedade Brasileira de Coloproctologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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