Medknow Publications on behalf of Indian Cancer Society
Abstract
BACKGROUND: Incidence of rectal cancer has wide geographical
variation. Disease pattern in developing countries is different from
developed countries as majority of the patients present in advanced
stage because of delayed referral and lack of uniform treatment
practices. AIMS: Present study describes the patient profile and
treatment results from a tertiary care cancer center in India. SETTING
AND DESIGN: Tertiary care Regional cancer center. Retrospective
analysis 89 patients with rectal adenocarcinoma treated between 1995
and 2002 were analyzed. METHODS: Patients with adenocarcinoma rectum
were evaluated in a G.I. Oncology clinic and were treated using
multimodality protocols involving surgery, radiotherapy and adjuvant
chemotherapy. STATISTICAL ANALYSIS: A descriptive analysis of patient
and disease profile,treatment patterns and out come was performed.
Survival analysis was performed using Kaplan-Meier method. RESULTS:
Mean age of the patients was 45.4 years and majority of them had tumor
in lower third of rectum with evidence of extrarectal spread. Seventy
five percent of the patients underwent curative resection with
abdominoperineal resection being the commonest procedure. Forty seven
percent of patients were given short course preoperative radiotherapy
and the remaining received postoperative radiotherapy. Sixty four
percent of patients could complete planned adjuvant chemotherapy.
Operative mortality was 2% and 23% had morbidity. Local recurrence rate
was 8.9%. 5-year disease free and overall survival was 54% and 58%
respectively. CONCLUSION: Majority of rectal cancer patients present
with locally advanced and low rectal growths leading to low sphincter
salvage rates. Despite the advanced stage of presentation optimal
oncologic results can be obtained by using a good surgical techniques
in combination with adjuvant radiotherapy and chemotherapy. Short
course preoperative radiotherapy seems to be more feasible in Indian
context. Timely referral and uniform treatment guidelines throughout
the country are needed for optimal management of rectal cancer in
India