Strategy to avoid local recurrence in patients with locally advanced rectal cancer

BACKGROUND: To clarify the short- and long-term outcomes of radical surgery after neoadjuvant chemoradiotherapy (NCRT) with TS-1 and irinotecan, which enhances radiosensitivity, in patients with locally advanced rectal cancer. METHODS: The study group comprised 105 patients with locally advanced rectal cancer who received NCRT followed by radical surgery. NCRT consisted of pelvic radiotherapy (45 Gy in 25 fractions over a period of 5 weeks), S-1 (80 mg/m(2)) given concurrently for 25 days, and irinotecan (60 mg/m(2)), given once a week as a continuous intravenous infusion. Radical surgery was performed 8 weeks after treatment. RESULTS: A pathological complete response was confirmed in 23.8%. The 5-year recurrence-free survival rate was 79.3%, and the 5-year overall survival rate was 87.1%. Multivariate analysis showed that the following 4 variables were independent predictors of recurrence-free survival: Sex (male: p = 0.0172), Pre-treatment tumor diameter (< 40 mm: p = 0.0223), Histopathological treatment response (grade 0,1: p = 0.0169), and ypN (ypN1: p = 0.1995; ypN2: p = 0.0007). Only ypN was an independent predictor of overall survival (ypN1: p = 0.0009; ypN2: p = 0.0012). CONCLUSIONS: Our treatment strategy combining TS-1 with irinotecan to increase radiosensitivity had a high response rate.