About 11,500 individuals will be diagnosed with rectal cancer and 4200 new cases will occur each year. About 4 of every 5 will receive adjuvant chemotherapy, but only 14 of every 1,000 will survive 5 year after diagnosis. The 5 year survival depends on disease stage, and this does appear to be higher than the national average. There is much variation both by disease stage and by surgical resections, which can have strong association with outcome. Patient education is needed to enable patients to make informed decisions about quality of life.
The data on rectal carcinoma in this study indicate that the patient's underlying factors are the most significant contributing factors to local advanced rectal carcinoma onset. Risk factors and preventive strategies should therefore be evaluated for patients presenting early with this condition.
We can summarize locally advanced rectal carcinomas are those that have invaded the circumferential (tumor infiltrates into the anal canal lumen), above the anal verge (deeper than 5 cm from the anal verge), the distal aspect of the distal rectum/sigmoid colon, the posterior aspect of levator ani myenterial muscle, the intervesical space, and the superficial surface of the pelvic floor.
More than 20 lesions have been found (6 were found in the rectum and 9 in the anus in patients without local recurrence) (Fig. 2.) On the basis of these findings we have confirmed the relevance of the T staging and the possibility of the existence of distant metastasis.
Treatment of locally advanced rectal carcinoma is dictated by the location of the tumor and other clinical factors such as local and regional spread, metastases, and treatment technique; the most frequently used treatment is chemoradiation for more than 6 weeks. Chemoradiation has been proven to increase local tumor control; metastases may remain in the resection specimen, so further radiotherapy has been recommended.
The present study shows that the survival in patients with locally advanced rectal carcinoma is affected by the degree of nodal involvement and tumor grade. Therefore, a careful follow-up after neoadjuvant chemoradiation is necessary in patients who are candidates for local resection.
Local therapy is a strong independent prognostic factor for survival in rectal carcinomas as well as a predictive factor for PFS that should facilitate clinical trials. Patients who will receive targeted therapy should be identified through pretreatment clinical assessment of tumour vascularization and TNM staging, preferably through endorectal ultrasound imaging.
Capecitabine given in doses of 50 or 65 mg/m2/d has shown to be an effective and well tolerated regimen for the treatment of locally advanced carcinoma of the rectum.
Capecitabine does not appear to improve overall or HRQOL. Although there are no differences between treatment groups in terms of appetite, weight, or diarrhoea, the results of this trial indicate that caution should be taken when considering the use of capecitabine as a single-agent in combination chemotherapy for patients with locally advanced rectal carcinoma. Clinicians can therefore focus on the adverse effects of capecitabine in further trials in this population. However, as it is generally well tolerated, the use of capecitabine or its fluorinated analogues should be reconsidered in the setting of metastatic colorectal carcinoma. This trial is registered with clinicaltrials.gov as NCT01627019.
In a recent study, findings demonstrated that the most common side effects associated with this chemotherapy regimen were gastrointestinal, and that capecitabine did not appear to cause haematological toxicity. The most common side effect was diarrhoea, which occurred in over 40% of patients and was mainly due to nausea or vomiting (n=22 and n=37, respectively, P<0.05). It was very important to administer a standard dose to ensure that patients and caregivers were correctly educated in how to handle and treat this disease. The capecitabine has a higher oral bioavailability than the 5-FU due to its chemical structure and oral administration.
Results from a recent clinical trial of the present study add further evidence that capecitabine is a highly effective agent in LARC. This result has been already demonstrated previously with gemcitabine.
The 5-year overall survival rate is 49% +/- 21% for Stage III [rectal cancer](https://www.withpower.com/clinical-trials/rectal-cancer)s. The 5-year disease-specific survival rate is 55% +/- 18% for Stage III cancers. The 5-year disease-specific survival and overall survival in Stage III rectal cancers are markedly worse compared with Stage II and Stage I cancers and are similar to the 5-year disease-specific and overall survival rates reported for locally advanced rectal cancers in the current literature. This may reflect a high risk of distant spread, which may lead to early metastasis in rectal cancer.