Neoadjuvant Chemoradiation Improves Sphincter Preservation without Significant Toxicity in Stage II Rectal Cancer

Open Access

Abstract

Background: Rectal cancer management increasingly emphasises sphincter preservation alongside oncological control. Neoadjuvant chemoradiation (nCRT) has emerged as an important approach in rectal cancer; however, its impact on sphincter preservation and toxicity remains variable, particularly in resource-limited settings. This study aimed to evaluate whether neoadjuvant chemoradiation improves sphincter preservation without significant toxicity in Stage II rectal cancer. Methods & Materials: This prospective comparative study was conducted from July 2011 to January 2017 at BSMMU, NICRH, and DMCH, Dhaka. A total of 60 patients with Stage II rectal adenocarcinoma were enrolled using purposive sampling and divided equally into two groups. Outcomes included sphincter-sparing surgery (SSS) rates and treatment-related toxicity. Data were analysed using SPSS version 26, with p<0.05 considered significant. Results: Most patients were aged 41-50 years (38.3%), with male predominance (58.3%). Sphincter-sparing surgery rates were higher in Group I (36.7%) compared to Group II (23.3%), while abdominoperineal resection rates were lower in Group I (13.3% vs 26.7%; p=0.032). Grade II nausea was most common (60% in both groups), with higher Grade III nausea in Group I (13.3% vs 3.3%). Vomiting and diarrhoea were predominantly Grade I-II with similar distributions. Proctitis and genitourinary toxicities were minimal, and haematological toxicity was mild with no Grade III/IV events. Conclusion: Neoadjuvant chemoradiation followed by surgery (Group I) demonstrated better sphincter preservation compared to surgery alone (Group II) without a significant increase in severe toxicity. These findings support the use of neoadjuvant chemoradiation as a safe and effective treatment strategy for patients with Stage II rectal cancer, particularly in resource-limited settings like Bangladesh.