Outcomes of multimodal treatment including preoperative chemotherapy for upper rectal cancer

Aim: to analyze outcomes of multimodal treatment including preoperative chemotherapy with FOLFOX 4 regimen in patients with upper rectal cancer.

Patients and Methods: the pilot study included 24 patients. Stages II and III were confirmed in 2 (8.3%) and 22 (91.7%) patients, respectively. All patients underwent 3 cycles of chemotherapy in FOLFOX 4 regimen followed by surgery. In the postoperative period, patients with T4 and N+ underwent adjuvant chemotherapy administered over 6 months including the time of preoperative treatment.

Results: all patients completed preoperative chemotherapy with the FOLFOX 4 regimen. The toxicity of chemotherapy was 38.9%; adverse events did not exceed grades I-II. Partial tumor regression (RECIST 1.1 criteria) was achieved in 18 (75.0%) patients. All patients underwent surgery 4 weeks after chemotherapy. Postoperative complications occurred in 4 (16.7%) patients, 1 (4.2%) had grade IIIb complication (Clavien-Dindo scale), which required re-surgery. Pathological complete response (TRG1 by Mandard scale) was revealed in 1 (4.2%) patient. Thirteen patients (54.2%) received adjuvant chemotherapy. The mean follow-up was 38 (17-54) months. Three patients (12.5%) developed local recurrence and 4 (16.7%) patients — distant metastases. The 3-year overall and diseasefree survival rates were 91.7% и 79.2%, respectively.

Conclusion: multimodal treatment including preoperative chemotherapy with the FOLFOX 4 regimen was well tolerated and produced tumor regression with high 3-year survival rates in patients with upper rectal cancer.

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