Hasan MORCALI, Metin FİGEN, Ayşe OKUMUŞ, Nazmiye Deniz ARSLAN, Hazım Orhan KIZILKAYA

Outcomes Of Neoadjuvant Chemoradiotherapy In Patients With Locally Advanced Rectal Cancer: A Single Institution Experience

Amaç: Neoadjuvan kemoradyoterapi lokal ileri rektum kanserli hastalarda standart tedavi töntemidir. Biz neoadjuvan kemoradyoterapi uygulanan lokal ileri rektum kanserli hastaların tedavi sonuçlarını retrospektif olarak incelemeyi amaçladık.Gereç ve Yöntem: Ocak 2009-Temmuz 2012 tarihleri arasında neoadjuvan kemoradyoterapi (KRT)/radyoterapi (RT) yapılan lokal ileri evre rektum kanseri 35 hastanın kayıtlı verileri geriye dönük olarak analiz edildi. Hastalar yaş,cinsiyet, histopatoloji, tümör yerleşim yeri, klinik ve patolojik tümör,lenf nodu,metastaz (TNM) durumu ile cerrahi sonrası histopatolojiktümör regresyon gradları (TRG) karılaştırmalı olarak değerlendirildi. Ayrıca yerel-bölgesel yineleme, uzak metastaz, genelsağkalım oranlarına bakıldı.Bulgular: Hastaların ortalama yaşı 56 (24-76) olup ortanca takip süreleri 21 ay (6-40 ay) ve hastaların 17’si (%48) kadın;18’i (%52) erkekti. Takip süresince lokal nüks sayısının 3 (%8,57) olduğu saptanmıştır. Tümör regresyon gradları ile tedaviöncesi T ve N evreleri arasında anlamlı ilişki vardı (P=0.10 ve 0.047, sırası ile). RT dozu ile TRG ve diğer parametreler arasında anlamlı ilişki bulunmadı. Eş zamanlı verilen KT rejimleri arasında tedavi sonuçları açısından anlamlı fark yoktu. Lokalnüks görülen hastalar incelendiğinde ise nüks durumu, tümör diferansiyasyonu (P=0.009) ve histolojisi arasında anlamlıilişki vardı (P=0.017). On hastada (%28,57) hiçbir yan etki görülmezken , 25 hastada (%71,48) ise 1. veya 2. derecedenakut dönem radyoterapi yan etkileri gözlendi. Yan etki görülen 25 hasta içinde en sık 18 vaka (%72,00) ile diare ve 17 vaka(%68,00) ile cilt toksisitesi gözlendi.Sonuç: Neoadjuvan radyokemoterapi lokal ileri rektum kanseri hastalarda lokal kontrole anlamlı katkı sağlayan, hastalarıntedavi sonrası hem T hemde N evrelerinde belirgin düşüşe sebep olan, ayrıca lokal yineleme oranlarını düşüren önemlibir tedavi yöntemidir

Anahtar Kelimeler:

Rectal kanser, neoadjuvant keemoradioterapi, tümör regresyon grade

Outcomes of neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer: a single institution experience.

Objectives: Neoadjuvant chemoradiotherapy (CRT) is the standard treatment for locally advanced rectal cancer. We aimto examine clinical outcomes in locally advanced rectal cancer patients treated with neoadjuvant CRT retrospectively.Material and Method: The medical records of 35 patients who were diagnosed with locally advanced stage rectal cancerwere analyzed retrospectively between the period of January 2009 and July 2012. Analyzed the data of patients wereage, sex, histopathological fi ndings, location of tumors, clinical and pathologic tumor, node, metastasis (TNM) withpostoperative histopathologic tumor regressions grades (TRG). Also, locoregional recurrence (LRR), distant metastases,and overall survival (OS) of the patients were determined..Results: The mean age of patients were 56 (24-76), the median follow-up time was 21 months (6-40 months) and 17patients (48%) were women, remaining 18 (52%) were male. During the follow-up period local recurrence was diagnosedin 3 (8,5%) patients. There was a signifi cant correlation between the tumor regression grade (TRG) with baseline T andN stage of the patients (P=0.10 and 0.047, respectively). There was no signifi cant correlation between the radiotherapydosage and TRG as well as the other parameters. There were no signifi cant differences between the regimens ofconcomitant chemotherapy for the clinical outcomes. When examined the patients with local recurrence there was asignifi cant correlation between recurrence status, tumor differentiation (P=0.009) and tumor histology (P=0.017). No sideeffects were seen in 10 patients (28.5%). Grade 1 or grade 2 acute side effects of radiation therapy were observed in 25patients (72%). Diarrhea was observed in 18 (72.00%) patients and dermatologic toxicities were in 17 (68.00%) in thesepatients.Conclusion: Neoadjuvant chemoradiotherapy is an important treatment method in patients with locally advanced rectalcancers. It laso contributes signifi cantly to local control and downstages for both T and N status. Local recurrence rateswere also lower in these patients.

Keywords:

Rectal cancer, neoadjuvant chemoradiotherapy, tumor regression grade,

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