Efectividad del tratamiento neoadyuvante radioterapia-capecitabina en la disminución del estadiaje del cáncer de recto en el Hospital Central de la Defensa

Abstract

INTRODUCTION: The therapeutic approach for rectal cancer has progressed significantly in the last years and neoadjuvant treatment is a nowadays a more frequent strategy used in rectum adenocarcinoma. There is an increasing tendency to apply sphincter conservative surgery, obtaining at a time much better results in means of local control of the disease. OBJECTIVES: Primary objective: Consider if this radio-chemotherpy neoadjuvant treatment reduces tumour’s stage in rectal cancer. Secondary objective: Consider if neoadjuvant treatment increases local control of the condition. Consider if neoadjuvant treatment increases global survival. Consider if radio-chemotherapy neoadjuvant treatment increases the percentage of patients for which sphincter conservative surgery can be achieved. MATERIALS AND METHODS: Between 2010 and 2016, a total of 139 patients were studied, of which 88 fulfilled inclusion criteria. Both male and female adult patients were included, those attending our Radiation Oncology Service between 2010 and 2016, coming from the same district of our Hospital, from ISFAS and other hospitals belonging to the Community of Madrid. After tumour histologic confirmation by means of endoscopic exploration, the staging of patients was made by pelvic Magnetic Resonance and abdomen-pelvic CT, according to TNM classification. Radio-chemotherapy treatment was given with 3D conformed radiotherapy with a 5x180 cGy fractioning, reaching a 5040 cGy dose, associated with Capecitabine at a dose of 825 mg/m2/12h v.o. to patients with a Rectal Adenocarcinoma diagnosis in T3-4, N+ stage, available for surgery, and after signing the informed consent. After 4-6 weeks from the end of the neoadjuvant treatment, patients went through surgery. The pathologic report of the piece of resection was again studied in order to review the degree of tumour reduction as result of the neoadjuvant treatment. Ryan et al. classification was used to review this grade of regression. RESULTS: 88,7% of the patients achieved some type of response after receiving the ultidisciplinary treatment described in “material and methods”. These results mean that there was an excellent response to the neoadjuvant treatment. Breaking down response degree according to the American Pathologist’ Association Ryan Classification, 20,5% of complete remissions were achieved (Ryan grade 0), 33% achieved a moderate response (Ryan grader 1) and a 35,2% of the patients obtained a minimum response (Ryan grade 2). Only 11,3% did not achieve response at all (Ryan 3). CONCLUSIONS: Radio-chemotherapic neoadjuvant treatment with radiotherapy reduces the staging of rectal cancer. We have achieved 20.5% of pathologic complete response. We have achieved 4,5 % of toxicity rates GIII-IV.