Background

LCCRT reduces local recurrence rates but its impact on sphincter preservation and survival are debated. An improved pathologic response is associated with better prognosis for an individual patient. The optimal chemotherapy regimen is unknown but our standard is continuous infusion 5-fluorouracil (FU) at 225/mg/m2/day. We compared the pathologic response rate in our population to that published in the literature. In addition, we audited the quality of the surgical specimens.

Methods

113 consecutive patients from January 2011 to December 2013 were identified as being treated at the Royal Brisbane and Women’s Hospital with LCCRT. Data was extracted for clinical and pathological staging, sphincter preservation and surgical quality as defined by grade of total mesorectal excision (TME).

Results

107 patients had a recorded clinical staging. 5 (5%) stage 1, 21 (20%) stage 2, 81 (76%) stage 3. 100 patients underwent surgery. Pathological staging showed 18% had a pCR, 30% were stage 1, 17% stage 2, 34% stage 3 and 13% not recorded. Pathological staging was increased in 7%, unchanged in 30%, improved by 1 stage in 23% and 2 stages in 20% for an overall downstaging of 59%. Sphincter preservation occurred in 58%. Complete TME occurred in 62% and nearly complete in 21%. Median time from LCCRT to surgery was 54 days.

Conclusion

Our outcomes, using continuous infusion FU with LCCRT in regards to downstaging were comparable to those reported in the literature. Surgical quality in regards to TME was comparable and timing of surgery after completion of LCCRT occurred within the 6-8 week timeframe recommended by international guidelines. Of note is that treatment occurred in a tertiary referral centre with a specialised colorectal service where difficult tumours, eg. low and locally advanced, and patients with significant comorbidities are referred. This may have had an influence on this data.