Clinical outcomes among patients with non-metastatic Rectal Cancer after chemo-radiotherapy (original) (raw)

Globally, colorectal cancer(CRC) is the third most commonly diagnosed cancer in males and the second in females, with over 1.2 million new cases and 608,700 deaths estimated to have occurred in 2008. (1)Rates are substantially higher in males than in females. Globally, the incidence of CRC varies over 10-fold. The highest incidence rates are in Australia and New Zealand, Europe and North America, and the lowest rates are found in Africa and South- entral Asia. These geographic differences appear to be attributable to differences in dietary and environmental exposures that are imposed upon a background of genetically determined susceptibility. At our center, where head and neck, breast and cervical cancers predominate, rectal cancers make for a small percentage of malignancies. In between 2009 and 2013, out of a total of 4307 patients treated with radiotherapy, carcinoma rectum accounted for only 97 cases (2.2%). Surgery remains the mainstay of curative treatment for carcinoma of the rectum. Surgical management depends on the stage and location of a tumor within the rectum. Very early cancers can be managed with limited surgery (i.e., local excision) in selected situations; however, the majority of tumors tend to present as more advanced disease and require either a low anterior resection (LAR) or abdominoperineal resection (APR). For patients with resected stage II or III rectal cancer, early randomized trials from Gastrointestinal Tumor Study Group (GITSG) and Mayo Clinic/North Central Cancer Treatment Group (NCCTG) demonstrated a significant local control and survival benefit for postoperative combined modality therapy over surgery alone. Thus, most of these patients stand to benefit from further adjuvant treatment in the form of concurrent chemoradiotherapy and adjuvant chemotherapy. Neoadjuvant or induction chemoradiotherapy is an increasingly used strategy for patients with rectal cancer. Advantages of the neoadjuvant approach include better local control, an increased likelihood of sphincter saving surgery, and a lower risk of chronic anastomotic stricture. Essential to the planning of Neoadjuvant therapy is an initial multidisciplinary assessment including the departments of surgery, radiotherapy and medical oncology. This study was conducted to evaluate our experience with Neoadjuvant and adjuvant chemoradiotherapy for rectal cancers.The study aims to estimate the local control rates and disease free survival of rectal cancer atients who undergo Neoadjuvant/adjuvant chemoradiotherapy with a curative intent at Shiridi Sai Baba Cancer ospital, Manipal.