Concurrent Chemotherapy and Radiotherapy Improves Sphincter Preservation without Significant Toxicity in Low Rectal Disease

Open Access

Abstract

Background: Rectal cancer is an important cause of cancer-related morbidity and mortality. Low rectal tumors often create major challenges in achieving sphincter preservation. Preoperative concurrent chemoradiotherapy may downstage Stage II rectal adenocarcinoma, improve respectability, and reduce the need for permanent colostomy, but local evidence from Bangladesh remains limited. Aim of the study: This study compared preoperative concurrent chemoradiotherapy followed by surgery with immediate surgery alone in patients with Stage II low rectal adenocarcinoma, focusing on sphincter preservation and treatment-related toxicity. Methods & Materials: This comparative interventional study was conducted from July 2011 to January 2017 at BSMMU, NICRH, and DMCH, Dhaka. A total of 60 patients with Stage II low rectal adenocarcinoma were enrolled purposively and divided into two groups: Group I received preoperative concurrent chemoradiotherapy followed by surgery, while Group II underwent immediate surgery. Treatment response, sphincter preservation, Karnofsky performance status, and treatment-related toxicities were assessed. Data were analyzed using SPSS version 26.0, and p<0.05 was considered statistically significant. Results: Among 60 patients, the mean age was 42.3 ± 10.17 years in Group I and 44.0 ± 10.47 years in Group II, with male predominance in both groups. Per rectal bleeding, complete response was observed in Group I, while alteration of bowel habit improved more in Group I than in Group II, 60.0% versus 52.0%, p<0.05. Karnofsky performance score also improved more in Group I. Sphincter-sparing surgery was significantly higher in Group I than Group II, 22 (73.3%) versus 14 (46.7%), p=0.032. Non-hematological toxicities were comparable between groups, and grade I neutropenia in Group I did not interrupt treatment. Conclusion: Preoperative concurrent chemoradiotherapy followed by surgery significantly improved sphincter preservation and functional outcome in selected patients with Stage II low rectal adenocarcinoma. It was well tolerated, with no significant increase in major non-hematological toxicity.