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Open Access Research article

Prognosis of rectal cancer patients improves with downstaging by intensified neoadjuvant radiochemotherapy - a matched pair analysis

Leif Schiffmann1*, Gunther Klautke2, Nicole Wedermann1, Michael Gock1, Friedrich Prall3, Rainer Fietkau4, Bettina Rau1 and Ernst Klar1

Author Affiliations

1 Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Schillingallee 35, Rostock 18057, Germany

2 Department of Radiotherapy, Sozialstiftung Bamberg, Buger Str. 80, Bamberg 96049, Germany

3 Institute of Pathology, University of Rostock, Strempelstr. 14, Rostock 18055, Germany

4 Department of Radiotherapy, University of Erlangen, Universitätsstr. 27, Erlangen 91054, Germany

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BMC Cancer 2013, 13:388  doi:10.1186/1471-2407-13-388

Published: 16 August 2013

Abstract

Background

Neoadjuvant radiochemotherapy has been proven superior to adjuvant treatment in reducing the rate of local recurrence without impairing cancer related survival or the incidence of distant metastases in standard protocols of neoadjuvant radiochemotherapy. The present study aimed at addressing the effects of an intensified neoadjuvant radiochemotherapy on long term cancer related and disease free survival.

Methods

A total of 387 patients underwent oncologic resection for rectal cancer in our institution between January 2000 and December 2009. There were 106 patients (27.4%) who received an intensified radiochemotherapy protocol completely and without excluding criteria (study group). A matched pair analysis was performed by comparing the study group with patients undergoing primary surgery and postoperative radiochemotherapy, if necessary and possible (control group). Matching was carried out in descending order for UICC stage, R-status, tumor height, T-, N-, V-, L-, M- and G-category of the TNM-system according to the histopathological staging. Follow-up data included local recurrence rate, cancer related and disease free survival.

Results

In the study group histopathological work-up of the specimen revealed a treatment response in terms of tumor regression in 92.5% (98/106) of these patients. Undergoing intensified neoadjuvant RCT the actuarial cancer related and disease free survival was 67.9% and 70.4%, local recurrence was 5.7% after an observation period of 4.3 ± 2.55 years. In the control group cancer related and disease free survival was 71.7% and 82.7%, local recurrence was 4.7% after an observation period of 3.8 ± 3.05 years revealing no statistical significant difference between the two groups. Moreover, estimated 5-year results of cancer related survival (66.7% vs 67.9% (controls)), the disease free survival (66.7% vs 79.9% (controls)) as well as subgroup analysis of UICC 0-III and UICC IV patients showed no difference between the study and control group as well.

Conclusion

In our study, intensified neoadjuvant radio-chemotherapy shows a high rate of tumor regression. The resulting inferior histopathological tumor stage shows the same long term local control and systemic tumor control as the control group with a primary more favorable tumor stage.

Keywords:
Rectal cancer; Intensified neoadjuvant radiochemotherapy; Cancer related survival; Disease free survival