EC Gastroenterology and Digestive System

Introduction: Multimodal treatment made of radio chemotherapy and surgery has improved the local control rate of rectal cancer but the metastatic relapse rate and overall survival remain stable.

Patients and Methods: Our work was a retrospective study of patients with locally advanced non-metastatic rectal cancer treated with radio-chemotherapy at Habib Bourguiba Sfax University Hospital in the period from January 2009 to December 2017. A descriptive analysis and a study of the survivals was done.

Results: We collected 66 patients. The tumor was in the lower rectum in 46 patients. According to the 2017 TNM classification, the tumors were classified as T3 in 49 cases. The disease was classified as N0 in 20 cases. Eleven patients had immediate surgery and 55 patients had received neoadjuvant therapy. The neoadjuvant treatment consisted of preoperative Radiotherapy concomitant with Chemotherapy for 53 patients. Ten patients did not undergo surgery. The predominant histological type was lieberkühnian adenocarcinoma in 47 cases. A T3 tumor was found in 24 patients operated after neoadjuvant treatment and 6 patients operated immediately. Lymph node involvement was observed in 25 patients. The clearance was less than 1 mm in 12 cases. For patients operated after neoadjuvant treatment, a complete histological response was obtained in six patients (13.3%). The adjuvant treatment consisted of adjuvant RT-CT for the eleven patients operated on immediately. Adjuvant Chemotherapy was administered in 29 patients operated after neoadjuvant treatment. It was associated with adjuvant RT in four cases. At the first post-treatment evaluation, 43 patients (65.1%) were in complete remission. Thirteen relapses were recorded after a median delay of 17 months (11 - 72 months). The 5-year OS and SES were 53% and 60% respectively, and the 5-year DFS was 82%. DFS at 5 years was 73%.

Conclusion: The prognosis of rectal cancers remains reserved. Accurate pre-therapeutic evaluation and optimization of neoadjuvant treatment according to prognostic factors of the disease could improve oncological results while preserving a good quality of life.

Keywords: Rectal Cancers; Neoadjuvant Treatment; Radiotherapy; Chemotherapy

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