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

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


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.


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Fig. 1.
Overall, disease-free, locoregional relapse-free, and distant metastasis-free survival rates of all patients.
Fig. 2.
Complication-free survival rates according to the use of hyperthermia (p=0.293).
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
  Male 43 (36.8) 73 (83.0) <0.001
  Female 74 (63.2) 15 (17.1)  
  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)  
  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
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      
  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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