Resumen

CASTANO LL, Rodrigo et al. Estudio multicéntrico de quimiorradioterapia pre y postoperatoria en estados II y III de cáncer de recto. Rev Col Gastroenterol [online]. 2005, vol.20, n.4, pp.25-34. ISSN 0120-9957.

OBJECTIVE. To determine whether preoperative adminis-tration of combination chemotherapy and external beam irradiation ("chemoradiation") for patients with stage II or stage III rectal carcinoma had an impact on perioperative morbidity or oncologic outcome, as compared with patients not receiving preoperative chemoradiation or postoperative chemoradiation. DESIGN. A group of patients with stage II or stage III middle or low rectal carcinoma receiving preoperative chemoradiation were followed up prospectively and compared in a nonrandomized fashion with an inception cohort group of similar patients without chemoradiation or postoperative radiation. SETTING. Oncologic units of Hospital Pablo Tobón Uribe and Hospital San Vicente de Paúl, Medellín-Colombia, tertiary care academic medical centers. PATIENTS AND METHODS. Between January 1999 and December 2004 forty patients with advanced rectal carcinoma (T2, T3, T4, and/or N1, N2) undergoing preoperative chemoradiation were compared with 38 patients not undergoing preoperative chemoradiation and 38 patients with postoperative chemoradiotherapy. External beam radiation, 45 to 50 Gy, was delivered concurrently with fluorouracil (450 mg/m2) and leucovorin (20 mg/m2) 4 to 8 weeks prior to surgical resection. Postoperative chemoradiotherapy was administered every 3 weeks simultaneous with cycles of chemotherapy with similar doses. MAIN OUTCOME MEASURES. Patients were followed up at regular intervals for either tumour recurrence or death. In addition, the group receiving chemoradiation was evaluated for major perioperative morbidity. Secondary targets include the evaluation of curative resections (R0), sphincter-preserving procedures, toxicity for chemoradiotherapy and surgical complications. RESULTS. All patients agreeing to preoperative chemoradiation completed therapy. Severe toxicity for chemoradiotherapy was slightly frequent and the most common were nauseas and vomiting followed by diarrhoea, without statistical differences between two groups. The postoperative morbidity was 35% and 42% for the patients with chemoradiation in the pre and postoperative and of 34% in which not receive chemoradiation. Preoperative chemoradiation left residual microscopic tumour in three patients, nevertheless there was residual tumour macro neither in the preoperative chemoradiation nor positive margins in contrast to the postoperative chemoradiation (16% positive margins) and without chemoradiation (5% positive margins). Sphincter-preserving procedures found more procedures in the preoperative chemoradiation (80%) that in the postoperative QRT (55 %) or those that there did not receive chemoradiation (50%). Relapsed and died in the preoperative chemoradiation 10 and 3 patients, in the postoperative chemoradiation 10 and 7 patients and in that they did not receive chemoradiation 8 and 7 patient. Free survival period for the chemoradiation pre, postoperative chemoradiation and without chemoradiation was 26, 26 and 35 months and the global survival was 28, 29 and 35 months respectively. CONCLUSIONS. The preoperative chemoradiation in the treatment of the low and middle rectal cancer, stage II and III is tolerated well and it does not collaborate to a major postoperative morbidity. Also, the local control, the postoperative morbidity, the free period of illness and the global survival favours the group with preoperative QRT in a not randomized group of patients, on having compared them with the patients who receive the postoperative QRT or without QRT.

Palabras clave : Rectal cancer; chemotherapy; radiotherapy; neoadjuvant; sphincter-preserving procedures.

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