Preoperative Concurrent Chemoradiotherapy Combined with Total Mesorectal Excision in Treatment for Locally Advanced Lower Rectal Cancer

Objective To evaluate the efficacy of preoperative concurrent chemoradiotherapy combined with total mesorectal excision(TME)in treatment for locally advanced lower rectal cancer.Methods The clinical data of 31 patients with locally advanced lower rectal cancer received concurrent chemoradiotherapy from January 2009 to December 2011 in this hospital were analyzed retrospectively.Conventional fraction radiotherapy with total dose 50 Gy and chemotherapy with mFOLFOX6 or CapeOX regimen were taken.The efficacy was assessed by recording results of clinical and pathological examination.The function of sphincter was also recorded.Results All 31 patients underwent TME operation.The complication morbidity and mortality was 12.9%(4/31)and 3.2%(1/31),respectively.As a result of the preoperative management,the tumor was reduced by an average of 21.9%,down-regulation of T stage was observed in 48.4%(15/31)patients,the frequency of lymph node metastasis decreased from 83.9%(26/31)to 38.7%(12/31).Pathological complete response was observed in 5 patients(16.1%)and the total response rate was 74.2%(23/31),grade 3/4 toxicity was occurred in 2(6.5%)patients.84.6%(22/26)of patients underwent sphincter preservation surgery reserved good function of sphincter.Conclusions Preoperative concurrent chemoradiotherapy combined with TME in treatment for locally advanced lower rectal cancer is effective and safe,which can lead to pathological complete response,decrease the tumor stage and the rate of lymph node metastasis,and can also increase the efficacy of operation.