Evaluation of the role of neoadjuvant chemotherapy in the management of rectal cancer

Document Type : Original Article

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Department of General Surgery, Faculty of Medicine, Menofia University, Menofia, Egypt

Abstract

Background: The current standard of care for locally advanced rectal cancer is neoadjuvant chemoradiotherapy followed
by surgery. Recent research has highlighted the possible advantages of induction chemotherapy before concurrent
Chemoradiotherapy (CRT) for individuals with locally advanced rectal cancer (LARC). Our research assesses the efficacy
and viability of induction chemotherapy before concomitant chemoradiotherapy for locally advanced rectal cancer.
Patients and Methods: Forty patients with locally advanced cancer rectum were enrolled in our study in 2019–2021.
Initially, they underwent an induction chemotherapy regimen consisting of 3 cycles of FOLFOX (oxaliplatin, leucovorin, 5
fluorouracil) over 3 months. Response assessment of the patients was done by pelvic MRI. Concurrent chemoradiotherapy
was given 2 weeks after completion of induction chemotherapy. Four weeks later, the patients were reassessed by pelvic
MRI, computed tomography chest, and abdomen. Total mesorectal excision was performed at 6–8 weeks after the end
of radiotherapy. Included patients were evaluated for pCR, Circumferential resection margins (CRM), RO resection,
sphincter preservation, treatment toxicity, and postoperative morbidity and mortality.
Results: In this study, sphincter preservation was achieved in eight out of 21 (38%) patients with low rectal tumors less
than or equal to 5 cm who were candidates for Abdominoperineal resection (APR) and shifted to Anterior resection (AR);
complete pathological response was achieved in seven (20.5%) patient; R0 resection was achieved in 34 (92%) patients;
CRM was positive in three patients; two of them developed local recurrence and one of them developed distant metastasis.
Conclusion: For locally advanced rectal cancer, induction chemotherapy followed by neoadjuvant chemotherapy,
radiation, and surgery would be a safe and effective treatment option.

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