Neoadjuvant concurrent chemoradiotherapy combined with surgery in patients with locally advanced middle and lower rectal cancer

Objective: To evaluate the efficacy and safety of neoadjuvant concurrent chemoradiotherapy combined with total mesorectal excision(TME)for the treatment of locally advanced middle and lower rectal cancer.Methods: Forty patients with locally advanced middle and lower rectal cancer were recruited between September 2011 and September 2012,18 of whom had stage Ⅱ(T3-4N0M0)and 22 had stage Ⅲ(T1-4N1-2M0).All patients received neoadjuvant concurrent chemoradiotherapy(the total dose of preoperative radiotherapy was 50 Gy,1.8 Gy/fx,concurrently combined with capecitabine plus oxaliplatin).The surgical operation was performed 6-8 weeks after concurrent chemoradiotherapy,following the principle of TME.Results: All patients completed the neoadjuvant concurrent chemoradiotherapy.Among these forty patients,8 received complete response,22 received partial response,10 received stable disease.And 30 patients obtained downstaging(75%).31 patients received low/ultra-low anterior resection(Dixon),and 9 patients received abdominoperineal resection(Miles) 6-8 weeks after chemoradiotherapy.The sphincter preservation rate was 77.5%(31/40).No perioperative death was observed,and the overall incidence of complication was 25.0%(10/40).As a result of examination of the surgical specimens,7 patients had a complete pathologic response,down-staging was obtained.Conclusion: Neoadjuvant concurrent chemoradiotherapy combined with TME for treatment of locally advanced middle and lower rectal cancer was effective and safe,which reduced the tumor stage and increased the complete tumor resection and sphincter preservation rates,and could also improve the quality of life.