Response to preoperative chemoradiation increases the use of sphincter‐preserving surgery in patients with locally advanced low rectal carcinoma

作者：Christopher H. Crane, John Michael Skibber, Barry W. Feig, Jean‐Nicolas Vauthey, Howard D. Thames, Steve A. Curley, Miguel A. Rodrı́guez-Bigas, Robert A. Wolff, Lee M. Ellis, Marc E. Delclos, Edward H. Lin, Nora Anita Janjan · 发表于：Cancer · 年份：2003 · DOI：10.1002/cncr.11075 · 被引用次数：183 · 研究领域：Colorectal Cancer Surgical Treatments、Colorectal and Anal Carcinomas、Anorectal Disease Treatments and Outcomes

BACKGROUND: Although controversial, some believe that preoperative chemoradiation increases the use of sphincter-preserving surgery in low rectal carcinoma patients. This article investigates the relationship between objective tumor response and sphincter preservation in low rectal carcinoma patients. METHODS: The authors reviewed the records of 238 patients with T3 or T4 low rectal carcinoma (< or = 6 cm from the anal verge) who underwent preoperative pelvic chemoradiation (45 Gy/25 fractions/5 weeks, n = 182 or 52.5 Gy/30 fractions/5 weeks, n = 56 with continuous infusion 5-fluorouracil at 300 mg/m(2), Monday to Friday) followed by mesorectal (n = 223) or local excision (n = 15). A logistic regression analysis was used to analyze the influence of objective tumor response (defined as complete clinical response) and other prognostic factors on sphincter preservation. Because degrees of partial response could not be objectively defined retrospectively, the influence of partial response on sphincter preservation could not be evaluated. RESULTS: Overall, 49% of patients (117 of 238) had sphincter-preserving surgery. The clinical complete response rate was 47%. Independent predictors of sphincter preservation included the year of surgery, tumor distance from the anal verge, circumferential tumor involvement, and response to chemoradiation. The sphincter preservation rate increased over the period of the study (from 28% [December 1989 to December 1992] to 44% [January 1993 to Dece...