PURPOSE: Adverse events may occur in patients receiving preoperative radiotherapy (PRT) for rectal cancers. The aim of this study is to clarify the clinical and pathological features of the patients with PRT-related adverse events, and the significance of the adverse events on the clinical outcome. METHODS: Seventy-five patients with T3 or T4 low rectal cancers curatively resected following PRT were studied. Thirty-one patients received radiotherapy, and 44 patients received chemoradiotherapy with tegafur-uracil and leucovorin. The total radiation dose was 50-50.4 Gy given in 25-28 fractions and the operation was performed 4-8 weeks after PRT. PRT-related adverse events were graded in accordance with the Common Terminology Criteria for Adverse Events v3.0. RESULTS: The most frequent adverse events were leukocytopenia and diarrhea, observed in 12% and 24% of patients, respectively. The majority of the leukocytopenia and diarrhea was grade 1-2 toxicity. Women experienced leukocytopenia more frequently than men (28% vs. 7%, p = 0.0317); however, no other predisposing factor for adverse events was recognized. Patients with leukocytopenia or diarrhea showed a better 5-year relapse-free survival rate than those without (94 ± 5% vs. 49 ± 9%, p = 0.00054), and the presence of these adverse events was an independent prognostic factor in a multivariate analysis. CONCLUSIONS: The presence of leukocytopenia or diarrhea was an independent predictor of a fair prognosis after curative operation following PRT, and thus these adverse events seem not to discourage oncologists and patients from considering PRT for rectal cancers.
PURPOSE: Adverse events may occur in patients receiving preoperative radiotherapy (PRT) for rectal cancers. The aim of this study is to clarify the clinical and pathological features of the patients with PRT-related adverse events, and the significance of the adverse events on the clinical outcome. METHODS: Seventy-five patients with T3 or T4 low rectal cancers curatively resected following PRT were studied. Thirty-one patients received radiotherapy, and 44 patients received chemoradiotherapy with tegafur-uracil and leucovorin. The total radiation dose was 50-50.4 Gy given in 25-28 fractions and the operation was performed 4-8 weeks after PRT. PRT-related adverse events were graded in accordance with the Common Terminology Criteria for Adverse Events v3.0. RESULTS: The most frequent adverse events were leukocytopenia and diarrhea, observed in 12% and 24% of patients, respectively. The majority of the leukocytopenia and diarrhea was grade 1-2 toxicity. Women experienced leukocytopenia more frequently than men (28% vs. 7%, p = 0.0317); however, no other predisposing factor for adverse events was recognized. Patients with leukocytopenia or diarrhea showed a better 5-year relapse-free survival rate than those without (94 ± 5% vs. 49 ± 9%, p = 0.00054), and the presence of these adverse events was an independent prognostic factor in a multivariate analysis. CONCLUSIONS: The presence of leukocytopenia or diarrhea was an independent predictor of a fair prognosis after curative operation following PRT, and thus these adverse events seem not to discourage oncologists and patients from considering PRT for rectal cancers.
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