255. Rectal cancer treatment and complications in IBD patients

ABSTRACTS S103

95% CI 0.11-0.43; OR rectosigmoid/rectum versus colon 0.65: 95% CI

0.46-0.90). Crude 5-year overall survival was higher in the group of pa-

tients who underwent additional surgical resection as compared to patients

who underwent polypectomy only (82% versus 75%, p¼0.002). Also after

adjusting for patient and tumour characteristics, patients who underwent

additional surgical resection had a decreased risk of death as compared

to patients who underwent polypectomy only (HR 0.68: 95% CI 0.50-

0.93).

Conclusions: Elderly with a tumour located in the rectosigmoid or

rectum were less likely to undergo additional surgical resection. Given

that additional surgical resection was independently associated with

improved overall survival, this might imply that all pT1 CRC patients

should receive additional surgical resection after initial polypectomy.

No conflict of interest.

http://dx.doi.org/10.1016/j.ejso.2014.08.244

253. Hypofractionated chemoradiotherapy with local hyperthermia

and metronidazole for fixed or tethered T4 rectal cancer

S. Gordeyev1, Y.U.A. Barsukov1, S.I. Tkachev2

1 Blokhin Cancer Research Center, Proctology, Moscow, Russian

Federation2 Blokhin Cancer Research Center, Radiational Oncology, Moscow,

Russian Federation

Background: Preclinical studies support additive effect of hypofrac-

tionated radiotherapy, local hyperthermia and metronidazole. The aim of

this study was to prospectively evaluate the safety and efficacy of neoad-

juvant chemoradiotherapy with local hyperthermia and metronidazole for

fixed T4 rectal cancer.

Methods: Patients received radiation therapy 40 Gy in 10 fractions

thrice a week. Chemotherapy consisted of Capecitabine 650 mg/m2 bid

per os on days 1-22, oxaliplatin 50 mg/m2 intravenously on days 3, 10,

17. Local hyperthermia 41-45�C, 60 minutes was performed on days 8,

10, 15, 17. Metronidazole 10 g/m2 per rectum was used on days 8, 15. Sur-

gery was carried out within 6-8 weeks after neoadjuvant treatment. Pri-

mary endpoint was R0 rate. Secondary endpoints included toxicity,

tumor regression, 2-year OS and DFS, local recurrence rate.

Results: Between Sept.2007 and Jan.2011, a total of 116 consecutive

patients were enrolled (median age 57 years; 72 male, 44 female; median

tumor diameter 8 cm). R0 resection rate was 90,5%. 5(4,3%) patients re-

mained inoperable, 6(5,2%) had R1 resection. 26(22,4%) patients experi-

enced G3-G5 toxicity (23 Grade 3/4 and 3 Grade 5). There was no

postoperative mortality. 48(41,4%) patients had near-complete and

10(8,6%) patients - complete response. Median follow-up was 21.9

months. 2-year OS was 82.6%, 2-year DFS was 70.9%. 30(25.9%) patients

had disease progression. 13(11.2%) patients had local recurrences,

22(19%) patients developed metastatic disease.

Conclusion: High R0 resection rate in fixed or tethered rectal cancer in

our study warrants further investigation of the proposed treatment scheme

in a randomized setting.



254. A novel chemoradiotherapy regimen for squamous-cell anal

cancer

A. Malikhov1, U.A. Barsukov1, A.V. Nikolaev1, D.F. Kim1, U.M.

Timofeev1

1 Blokhin’s Russian Cancer Research Center, Coloproctology, Moscow,

Russian Federation

The aim of this trial was to investigate safety and efficacy of anal

cancer chemoradiotherapy with cisplatin, bleomycin and local

hyperthermia.

Methods: This retrospective trial included 157 consecutive patients,

who underwent chemoradiotherapy for squamous-cell anal cancer during

1998-2011. All patients received 36-48 Gy radiotherapy in 2 Gy fractions

followed by a boost (after 2 week gap) till a total dose of 64-70 Gy was

achieved. Chemotherapy included intravenous cisplatin 20 mg/m2 days

1,3 weeks 1-4, intramuscular bleomycin days 2,4, weeks 1-4. 5 sessions

of local 41-45 C hyperthermia were carried out during the radiotherapy

course.

Results: Complete clinical response was achieved in 126 (80,3%) pa-

tients, 31 (19,7%) patients underwent abdominoperineal resection. Median

followup was 30 months. 24 (16,9%) patients died from disease progres-

sion, including 10 (7,0%) patients with local recurrence. 5-year survival

rate was 73,7 %.

Conclusion: Anal cancer chemoradiotherapy with cisplatin, bleomycin

and local hyperthermia seems a feasible alternative to standard treatment,

the efficacy of this regimen needs to be validated in prospective trials.



255. Rectal cancer treatment and complications in IBD patients

S.J. VanRooijen1, S.L. Bosch2, H.J.W. Braam1, G.M.J. B€okkerink1, I.D.

Nagtegaal2, J.H.W. De Wilt1

1 Radboud University Medical Center, Surgery, Nijmegen, Netherlands2 Radboud University Medical Center, Pathology, Nijmegen, Netherlands

Background: IBD patients have an increased risk of developing colo-

rectal cancer(CRC). For sporadic rectal cancer (RC), neoadjuvant therapy

followed by total mesorectal excision (TME), is standard of care. Data on

the effects of this treatment for IBD related RC are rare, since IBD patients

are usually excluded from neo-adjuvant trials.

Materials and methods: All IBD patients of the Netherlands with RC

between 1990 and 2010were selected using a nationwide search in theDutch

Pathology Database (PALGA). Clinical data were collected from detailed

medical record review in each hospital. All histopathological slides were re-

viewed to confirm both diagnoses. Surgical complications were scored ac-

cording to the Clavien-Dindo scale (Grade 1 to 5). Results from IBD

patientswithRCwere comparedwith data from theDutch surgical colorectal

audit containing all CRC patients treated in the Netherlands.

Results: 173 patients from 40 hospitals were identified (89 Ulcerative

Colitis (UC), 70 Crohn’s Disease (CD), 14 indeterminate colitis). 112

(64.7%) were males and 61 (35.3%) females with mean age of RC diag-

nosis of 60.7 years (28.2e92.4). The mean duration of IBD before devel-

opment of RC was 17.4 years (0e50.9). Neoadjuvant therapy was used in

63 (36.4%) patients, 29 (17.9%) received short course radiotherapy (RT),

13(8.3%) long course RT, 21 (13.1%) chemoradiation therapy (CRT). 154

(89.1%) patients underwent resection of the tumor. Diagnosis of RC was

known preoperatively in 145 (83.8%) patients (CD 72.7% and UC

90.9%; p¼0.022). Stage distribution was: 1 patient stage 0 (0.9%), 27 stage

I (23.9%), 41 stage II (36.3%), 30 stage III (26.5%), and 14 stage IV

(12.4%). 42% of the patients developed one or several complications after

rectal surgery. Complication grade 2 was reported most, 26 (27,4%) times,

as a presacral or intra-abdominal abscess (15.8%), perineal or abdominal

wound (26.3%) or urologic (20%) cause. 48 grade 3+ complications

were reported in 41 (24.4%) patients. No more complications were seen

with neoadjuvant therapy usage nor immunosuppressive. Local recurrence

was seen in 14 (8,1%) patients.

Conclusions: Rectal cancer is often not recognized in patients with

IBD who undergo surgery. This leads to a high number of R1 resections

and an increased local recurrence rate, especially in patients with CD.

The complication rate after TME surgery in IBD patients seems compara-

ble with sporadic RC patients.







255. Rectal cancer treatment and complications in IBD patients

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