Do all locally advanced rectal cancers require radiation? A review of literature in the modern era

Efficacy of preoperative systemic vein chemotherapy combined with regional intra-arterial chemoembolization in the management of locally advanced rectal cancer

AIM: To evaluate the effectiveness and safety of preoperative systemic vein chemotherapy combined with regional intra-arterial chemoembolization in the management of locally advanced rectal cancer.

METHODS: Clinical data for 320 patients with locally advanced rectal cancer treated at the First Affiliated Hospital of Zhengzhou University from January 2008 to July 2012 were retrospective. The patients were divided into two groups, patients who received preoperative systemic vein chemotherapy combined with regional intra-arterial chemoembolization (group A, n = 148) and those who received preoperative radiotherapy combined with chemotherapy (group B, n = 172). All cases involved in this study were treated with neoadjuvant therapy followed by anterior resection 3 to 4 weeks later. The overall effective rate, the incidence of adverse reactions and postoperative complications were compared between the two groups.

RESULTS: All patients had surgical specimens eligible for histopathological assessment. The overall satisfaction rate was significantly higher in group A than in group B (57.6% vs 44.8%, P < 0.05). The incidence of adverse reactions (except nausea) and postoperative complications such as anastomotic leakage, intestinal obstruction and poor wound healing were all lower in group A than in group B (all P < 0.05), while the incidence of nausea was higher in group A (χ² = 31.16, P < 0.001). There was no perioperative mortality related to neoadjuvant therapy in both groups.

CONCLUSION: Preoperative systemic vein chemotherapy combined with regional intra-arterial chemoembolization is associated with better efficacy and fewer adverse reactions and postoperative complications in the management of locally advanced rectal cancer.