Journal List > Prog Med Phys > v.25(2) > 1098465

Yea: Postoperative Complications after Preoperative Chemoradiotherapy Combined with Hyperthermia in Locally Advanced Rectal Cancer

Abstract

We investigated whether regional hyperthermia (HT) increased post-surgical complications in patients with locally advanced rectal cancer treated with preoperative concurrent chemoradiotherapy (CCRT). Between 1996 and 2007, 205 patients treated with preoperative CCRT and curative surgery were evaluable for the analysis of acute and late toxicities. A total dose of 39.6 Gy or 45 Gy was delivered concurrently with one or two cycles of chemotherapy (5-fluorouracil, leucovorin). Eighty-eight patients received regional HT twice a week using an 8-MHz radiofrequency capacitive heating device. Surgery was performed 4∼6 weeks after the completion of preoperative CCRT. The median age was 59 years (range, 18∼83) and the median follow-up period was 61months (range, 2∼191). The 5-year overall survival and complication-free survival rate of all patients was 77.4% and 73.7%, respectively. Early leakage, delayed leakage, anastomotic stricture, fistula, and small bowel obstruction occurred in 1.0%, 2.9%, 1.5%, 5.9%, and 17.1%, respectively. HT did not increase all kinds of complications. The 5-year complication-free survival rate was 71.8% in the non-HT group and 76.3% in the HT group (p=0.293). Regional HT did not increase postoperative complications in patients with locally advanced rectal cancer treated with preoperative CCRT followed by curative surgery.

References

1. McCall JL, Cox MR, Wattchow DA. Analysis of local recurrence rates after surgery alone for rectal cancer. Int J Colorectal Dis. 10:126–32. 1995.
crossref
2. NIH consensus conference. Adjuvant therapy for patients with colon and rectal cancer. JAMA. 264:1444–1450. 1990.
3. Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 351:1731–1740. 2004.
crossref
4. Horsman MR, Overgaard J. Hyperthermia: a potent enhancer of radiotherapy. Clin Oncol (R Coll Radiol). 19:418–26. 2007.
crossref
5. De Haas-Kock DF, Buijsen J, Pijls-Johannesma M, et al. Concomitant hyperthermia and radiation therapy for treating locally advanced rectal cancer. Cochrane Database Syst Rev. 2009. CD006269.
crossref
6. Kang MK, Kim MS, Kim JH. Clinical outcomes of mild hyperthermia for locally advanced rectal cancer treated with preoperative radiochemotherapy. Int J Hyperthermia. 27:482–490. 2011.
crossref
7. Berdov BA, Menteshashvili GZ. Thermoradiotherapy of patients with locally advanced carcinoma of the rectum. Int J Hyperthermia. 6:881–890. 1990.
crossref
8. van der Zee J, Gonzalez Gonzalez D, van Rhoon GC, van Dijk JD, van Putten WL, Hart AA. Comparison of radiotherapy alone with radiotherapy plus hyperthermia in locally advanced pelvic tumours: a prospective, randomised, multicentre trial. Dutch Deep Hyperthermia Group. Lancet. 355:1119–1125. 2000.
9. Maluta S, Romano M, Dall'oglio S, et al. Regional hyperthermia added to intensified preoperative chemoradiation in locally advanced adenocarcinoma of middle and lower rectum. Int J Hyperthermia. 26:108–117. 2010.
crossref
10. Anscher MS, Lee C, Hurwitz H, et al. A pilot study of preoperative continuous infusion 5-fluorouracil, external microwave hyperthermia, and external beam radiotherapy for treatment of locally advanced, unresectable, or recurrent rectal cancer. Int J Radiat Oncol Biol Phys. 47:719–24. 2000.
crossref
11. Wust P, Rau B, Gellerman J, et al. Radiochemotherapy and hyperthermia in the treatment of rectal cancer. Recent ResultsCancer Res. 146:175–191. 1998.
crossref
12. Rau B, Wust P, Hohenberger P, et al. Preoperative hyperthermia combined with radiochemotherapy in locally advanced rectal cancer: a phase II clinical trial. Ann Surg. 227:380–389. 1998.
13. Ceelen WP, Van Nieuwenhove Y, Fierens K. Preoperative chemoradiation versus radiation alone for stage II and III resectable rectal cancer. Cochrane Database Syst Rev. 2009. CD006041.
crossref
14. Schulze T, Wust P, Gellermann J, et al. Influence of neoadjuvant radiochemotherapy combined with hyperthermia on the quality of life in rectum cancer patients. Int J Hyperthermia. 22:301–318. 2006.
crossref
15. Rullier E, Laurent C, Garrelon JL, Michel P, Saric J, Parneix M. Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg. 85:355–358. 1998.
crossref
16. Vignali A, Fazio VW, Lavery IC, et al. Factors associated with the occurrence of leaks in stapled rectal anastomoses: a review of 1,014 patients. J Am Coll Surg. 185:105–113. 1997.
crossref
17. Yeh CY, Changchien CR, Wang JY, et al. Pelvic drainage and other risk factors for leakage after elective anterior resection in rectal cancer patients: a prospective study of 978 patients. Ann Surg. 241:9–13. 2005.
18. Kim CW, Kim JH, Yu CS, et al. Complications after sphincter-saving resection in rectal cancer patients according to whether chemoradiotherapy is performed before or after surgery. Int J Radiat Oncol Biol Phys. 78:156–163. 2010.
crossref
19. Horie H, Kashiwagi H, Konishi F, Furuta K, Ozawa A, Kanazawa K. Improved outcome following preoperative radiochemotherapy: 40.5 Gy accelerated hyperfractionation and 5-fluorouracil suppositories for patients with carcinoma of the lower rectum. Surg Today. 29:992–998. 1999.
crossref
20. Eypasch E, Wood-Dauphinee S, Williams JI, Ure B, Neugebauer E, Troidl H. The Gastrointestinal Quality of Life Index. A clinical index for measuring patient status in gastroenterologic surgery. Chirurg. 64:264–274. 1993.

Fig. 1.
Overall, disease-free, locoregional relapse-free, and distant metastasis-free survival rates of all patients.
pmp-25-89f1.tif
Fig. 2.
Complication-free survival rates according to the use of hyperthermia (p=0.293).
pmp-25-89f2.tif
Table 1.
Patient and tumor characteristics.
  Patients (%) p-value
Hyperthermia (-) (n=117) Hyperthermia (+) (n=88)
Age (y)      
  Median (range) 58 (18∼81) 60 (33∼83) <0.304
Sex      
  Male 43 (36.8) 73 (83.0) <0.001
  Female 74 (63.2) 15 (17.1)  
Stage      
  cT3 115 (98.3) 85 (96.6) <0.653
  cT4 2 (1.7) 3 (3.4)  
  N(-) 77 (65.8) 59 (67.0) <0.853
  N(+) 40 (34.2) 29 (33.0)  
Radiation dose      
  39.6 Gy 61 (52.1) 37 (42.1) <0.152
  45.0 Gy 56 (47.9) 51 (57.9)  
Surgery      
  Abdominoperineal resection 16 (13.7) 15 (17.0) <0.900
  Ultra-low anterior resection 27 (23.1) 20 (22.7)  
  Low anterior resecti on 73 (62.4) 53 (60.2)  
  Transanal excision 1 (0.9) 0  
Table 2.
Complications after surgery.
  Hyperthermia (-) (n=117) Hyperthermia (+) (n=88) p-value
Early leakage 2 (1.7%) 0 0.508
Delayed leakage 6 (5.1%) 0 0.038
Small bowel 20 (17.1%) 15 (17.0%) 0.993
  obstruction      
Anastomotic stricture 1 (0.9%) 2 (2.3%) 0.578
Fistula 9 (7.7%) 3 (3.4%) 0.196
Table 3.
Ileostomy or colostomy status in patients wh received sphincter preservation surgery.
  Hyperthermia (-) (n=101) Hyperthermia (+) (n=73) p-value
Immediately after      
surgery      
  Presence 29 (28.7) 24 (32.9) 0.556
  No 72 (71.3) 49 (67.1)  
At the last follow-up      
  Presence 21 (20.8) 17 (23.3) 0.694
  No 80 (79.2) 56 (76.7)  
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