2024 Volume 3 Issue 4 Pages 281-288
Background: Neoadjuvant chemotherapy (NAC), which excludes radiation therapy (RT), has been investigated with the aim of lowering the local recurrence rate and suppressing distant metastasis in patients with rectal cancer, as well as avoiding the adverse events (AEs) of RT.
Aim: To clarify the therapeutic results of NAC for patients with locally advanced mid-low rectal cancer.
Materials and methods: We reviewed the data of 33 patients with stage II or III mid-low rectal cancer who underwent primary tumor resection after NAC between April 2015 and April 2018. We retrospectively analyzed the short-term treatment results, including clinicopathological factors, AEs, and perioperative complications, as well as the long-term treatment results, including the 5-year recurrence-free survival rate (RFS).
Results: The median observation period was 61.5 months (range, 29.6-97.0 months). All patients underwent SOX (S-1 + oxaliplatin) therapy. The most common AEs were thrombocytopenia in five patients (15.1%) and neutropenia in two patients (6.1%). Pathological complete response was achieved in three patients (7.8%). Recurrence was observed in six patients (18.2%), and in each case was a local recurrence event. The 5-year RFS rate was 81.8%. Multivariate analysis using the COX proportional hazards model showed that preoperative lymph node metastasis positivity (p = 0.03) and lymphatic invasion positivity (p < 0.001) were independent prognostic factors.
Conclusion: SOX therapy as preoperative chemotherapy has few adverse events and a low postoperative complication rate, and can be performed relatively safely. Because there were many local recurrences, local control with chemotherapy alone may be insufficient.