title: Preoperative infusional chemoradiation therapy for stage T3 rectal cancer.
abstract: OBJECTIVE
  To evaluate preoperative infusional chemoradiation for patients with operable rectal cancer.
  
  
  METHODS
  Preoperative chemoradiation therapy using infusional 5-fluorouracil (5-FU), (300 mg/m2/day) together with daily irradiation (45 Gy/25 fractions/5 weeks) was administered to 77 patients with clinically Stage T3 rectal cancer. Endoscopic ultrasound confirmed the digital rectal exam in 63 patients. Surgery was performed approximately 6 weeks after the completion of chemoradiation therapy and included 25 abdominoperineal resections and 52 anal-sphincter-preserving procedures.
  
  
  RESULTS
  Posttreatment tumor stages were T1-2, N0 in 35%, T3 N0 in 25%, and T1-3, N1 in 11%; 29% had no evidence of tumor. Local tumor control after chemoradiation was seen in 96% (74 out of 77); 2 patients had recurrent disease at the anastomosis site and were treated successfully with abdominoperineal resection. Overall, pelvic control was obtained in 99% (76 out of 77). The survival after chemoradiation was higher in patients without node involvement than in those having node involvement (p = n.s.). More patients with pathologic complete responses or only microscopic foci survived than did patients who had gross residual tumor (p = 0.07). The actuarial survival rate was 83% at 3 years; the median follow-up was 27 months, with a range of 3 to 68 months. Acute, perioperative, and late complications were not more numerous or more severe with chemoradiation therapy than with traditional radiation therapy (XRT) alone.
  
  
  CONCLUSIONS
  Excellent treatment response allowed two-thirds of the patients to have an anal-sphincter-sparing procedure. Gross residual disease in the resected specimen indicates a poor prognosis, and therapies specifically targeting these patients may improve survival further.
authors.affiliation: Department of Radiotherapy, University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
authors.forename: T A
authors.initials: TA
authors.lastname: Rich
authors.forename: J M
authors.initials: JM
authors.lastname: Skibber
authors.forename: J A
authors.initials: JA
authors.lastname: Ajani
authors.forename: D J
authors.initials: DJ
authors.lastname: Buchholz
authors.forename: K R
authors.initials: KR
authors.lastname: Cleary
authors.forename: R A
authors.initials: RA
authors.lastname: Dubrow
authors.forename: B
authors.initials: B
authors.lastname: Levin
authors.forename: P M
authors.initials: PM
authors.lastname: Lynch
authors.forename: S H
authors.initials: SH
authors.lastname: Meterissian
authors.forename: L D
authors.initials: LD
authors.lastname: Roubein
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D004334:Drug Administration Schedule; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011300:Preoperative Care; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D015996:Survival Rate
chemical_list: D005472:Fluorouracil