Neoadjuvant therapy for advanced rectal carcinoma in China: Whether radiochemotherapy is superior to radiotherapy?

To verify whether the 30 Gy preoperative radiotherapy regimen is effective to advanced rectal cancer, and whether the preoperative chemoradiation offers an advantage in sphincter preservation and tumor control compared with irradiation alone. A total of 141 patients administered neoadjuvant treatment with resectable lower rectal carcinoma from 2002 to 2006 were collected retrospectively. The patients were divided into two groups: preoperative radiotherapy alone (30Gy by 10 fractions) (PRT group) and preoperative chemoradiotherapy (PCRT group). All patients underwent radical surgery after neoadjuvant treatment. The overall sphincter-preservation rate was 68.8% (97/141), with no significant difference between the two groups. The overall downstaging rate was 48.2% (68/141), including 4 patients completely response (2.8%). The T and N downstaging rate were 30.5% (43/141) and 53.8% (57/106) respectively, showing no statistically difference between the two groups. The 2-year overall survival rate was 93.6%; no survival benefit were observed in PCRT group. The 2-year cumulative local recurrence rates were similar as well (4.2% vs 6.7%, P =0.63). Two patients with severe marrow suppression higher than grade 3 and 1 patient with severe perineum ulcer was observed in PCRT group, which did not occur in PRT group. The preoperative adjuvant treatment of 30Gy radiotherapy alone may be an optional treatment for Chinese lower rectal carcinoma. Preoperative chemoradiotherapy does not show actual superiority compared with radiotherapy alone.