Does Chemo-Radiation Therapy Influence Outcomes in Unresectable Locally Advanced State IV Rectal Cancer?

Abstract

Introduction: The median survival for patients with stage IV rectal cancer is approximately 20 months. Therapy should focus not only on improving survival but also on quality of life. The aim of our study was to determine if chemoradiation (C-RT) would improve palliation for metastatic unresectable locally advanced disease compared to patients receiving palliative chemotherapy alone (C) for stage IV cancer. Methods: Retrospective review of a prospectively maintained database at a single institution was carried out under IRB approval. From January 2004 to December 2008, 43 patients presenting with unresectable stage IV rectal cancer were identified with a median follow-up of 12 months. Patients with evidence of locally advanced disease or bulky disease received infusional 5-FU ± bevacizumab and 3D conformed mega voltage photon therapy (5400 cGy). Patients without evidence of bulky disease received either FOLFOX or FOLFIRI ± bevacizumab. Data on demographics, investigations, treatment, complications, metastasis, number of blood transfusions, days of hospitalization, and surgical intervention were analyzed using SPSS statistical software. p < 0.05 was considered statistically significant. Results: There were 25 and 18 patients in the C and C-RT groups respectively. There was no difference in mean age, sex or overall survival. Three patient (12%) in the C group developed hydronephrosis compared to 8 patients (44%) in the C-RT group (p < 0.05). Six patients (24%) developed bowel obstructions requiring an ostomy in the C group compared to 9 patient (50%) in the C-RT group (p = 0.07). In the C arm, 80% of patients required multiple hospitalizations for symptoms consistent with progression of disease compared to 61% of patients in the C-RT arm (p < 0.01). Conclusion: Chemoradiation in patients with locally advanced unresectable stage IV cancer has not been extensively investigated. At our institution, patients treated with C-RT for bulky stage IV rectal cancer required fewer hospitalizations when compared to those treated with chemotherapy alone.