Role of pelvic radiotherapy for locally advanced rectal cancer and synchronous unresectable distant metastases

Cancer Radiother. 2016 Dec;20(8):805-810. doi: 10.1016/j.canrad.2016.06.009. Epub 2016 Oct 21.

Abstract

Purpose: To evaluate the efficacy and safety of pelvic irradiation combined systematic chemotherapy in patients with locally advanced (cT3-T4 and/or cN+) rectal cancer and synchronous unresectable distant metastases.

Patients and methods: A total of 76 eligible patients who received pelvic radiotherapy and concurrent capecitabine-based chemotherapy were retrospectively reviewed. Patients survival curves were constructed using the Kaplan-Meier method, and a multivariate analysis was performed to identify independent prognostic factors.

Results: Most of the adverse events were mild during the period of combined chemoradiotherapy. Twenty-two patients experienced resection of primary tumour and 16 patients underwent radical surgery of all lesions. Only five patients had pelvic progression during the follow-up period. The median progression-free survival and median overall survival were 13 and 30 months, respectively. Radical surgery of all lesions following chemoradiotherapy was found to be an independent prognostic factor according to multivariate analysis.

Conclusions: Pelvic irradiation combined with systematic chemotherapy in patients with locally advanced rectal cancer and synchronous unresectable distant metastases is effective and tolerable, both for pelvic and distant control. A curative resection following chemoradiotherapy was associated with prolonged survival.

Keywords: Cancer du rectum; Chemoradiotherapy; Chimioradiothérapie; Curative resection; Metastatic; Métastatique; Non résécable; Pelvic radiotherapy; Radiothérapie pelvienne; Rectal cancer; Résection curative; Unresectable.

Publication types

  • Evaluation Study

MeSH terms

  • Adenocarcinoma / mortality
  • Adenocarcinoma / radiotherapy
  • Adenocarcinoma / secondary*
  • Adenocarcinoma / surgery
  • Adenocarcinoma / therapy
  • Adult
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Capecitabine / administration & dosage
  • Chemoradiotherapy
  • Combined Modality Therapy
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Humans
  • Kaplan-Meier Estimate
  • Liver Neoplasms / radiotherapy
  • Liver Neoplasms / secondary
  • Lung Neoplasms / radiotherapy
  • Lung Neoplasms / secondary
  • Male
  • Middle Aged
  • Pelvis
  • Prognosis
  • Proportional Hazards Models
  • Rectal Neoplasms / mortality
  • Rectal Neoplasms / radiotherapy*
  • Rectal Neoplasms / surgery
  • Rectal Neoplasms / therapy
  • Retrospective Studies

Substances

  • Capecitabine