Selective use of preoperative chemoradiotherapy for T3 rectal cancer can be justified: Analysis of local recurrence

Background: Preoperative chemoradiotherapy (CXRT) is performed to reduce local recurrence and improve the rate of radical resection for rectal cancer. Currently, it is recommended for all suspected T3 rectal cancers. However, the survival benefit of this procedure is controversial, and complications of RT are often overlooked. The present study was designed to assess the validity of our institutional policies regarding selective use of preoperative CXRT for T3 rectal cancer. Methods: From September 2006 to May 2010, we retrospectively analyzed data for patients with pathologic T3 rectal cancer, especially those with follow-up for more than 18 months. Patients who underwent RT pre-/postoperatively were excluded. Patients who fulfilled these criteria but did not undergo RT or had incurable distant metastasis were also excluded. Results: Of the 319 patients who underwent surgery for rectal cancer, 183 were diagnosed with T3 cancer. After excluding 58 patients, the final sample included 125 subjects with a mean follow-up of 26.0 months. In all, 94 patients had a follow-up of more than 18 months. Four patients had local recurrences, and the cumulative local recurrence rate was 3.4 % at 18 months and 5.6 % after 2 years. All four had low rectal cancer (mean distance 4.5 ± 1.9 cm). Three were diagnosed as N0 and one as N1. The mean disease-free period was 15.0 months. The distance between the tumor and the anal verge was the only significant risk factor for local recurrence. Conclusions: In this study, the oncologic outcome for T3 rectal cancer without preoperative CXRT was acceptable in terms of local recurrence. Selective use of preoperative CXRT for T3 rectal cancer needs to be further evaluated prospectively.