title: Preoperative hyperthermia combined with radiochemotherapy in locally advanced rectal cancer: a phase II clinical trial.
abstract: OBJECTIVE
  A prospective phase II study was performed to determine the feasibility and efficacy in terms of response rate, resectability, and morbidity in patients with locally advanced rectal cancer who received preoperative regional hyperthermia combined with radiochemotherapy (HRCT).
  
  
  BACKGROUND
  Recent studies suggest that preoperative radiochemotherapy in locally advanced rectal cancer can induce downstaging, but after resection the incidence of local recurrences remains high. Hyperthermia (HT) may add tumoricidal effects and improve the efficacy of radiochemotherapy in a trimodal approach.
  
  
  METHODS
  Thirty-seven patients with histologically proven rectal cancer and T3 or T4 lesions, as determined by endorectal ultrasound and computed tomography, entered the trial. 5-Fluorouracil (300-350 mg/m2) and leucovorin (50 mg) were administered on days 1 to 5 and 22 to 26. Regional HT using the SIGMA 60 applicator (BSD-2000) was given once a week before radiotherapy (45 Gy with 1.8-Gy fractions for 5 weeks). Surgery followed 4 to 6 weeks after completion of HRCT.
  
  
  RESULTS
  Preoperative treatment was generally well tolerated, with 16% of patients developing grade III toxicity. No grade IV complications were observed. The overall resectability rate was 32 of 36 patients (89%), and 31 resection specimens had negative margins (R0). One patient refused surgery. In 5 patients (14%), the histopathologic report confirmed no evidence of residual tumor (pCR). A partial remission (PR) was observed in 17 patients (46%). The survival rate after 38 months was 86%. In none of the patients was local recurrence detected after R0(L), but five patients developed distant metastases.
  
  
  CONCLUSIONS
  Preoperative HRCT is feasible and effective and may contribute to locoregional tumor control of advanced rectal cancer, which is to be proven in an ongoing phase III trial.
authors.affiliation: Virchow Klinikum at the Humboldt University of Berlin, Division of Surgery and Surgical Oncology, Robert-Roessle Hospital and Tumor Institute, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Rau
authors.forename: P
authors.initials: P
authors.lastname: Wust
authors.forename: P
authors.initials: P
authors.lastname: Hohenberger
authors.forename: J
authors.initials: J
authors.lastname: Löffel
authors.forename: M
authors.initials: M
authors.lastname: Hünerbein
authors.forename: C
authors.initials: C
authors.lastname: Below
authors.forename: J
authors.initials: J
authors.lastname: Gellermann
authors.forename: A
authors.initials: A
authors.lastname: Speidel
authors.forename: T
authors.initials: T
authors.lastname: Vogl
authors.forename: H
authors.initials: H
authors.lastname: Riess
authors.forename: R
authors.initials: R
authors.lastname: Felix
authors.forename: P M
authors.initials: PM
authors.lastname: Schlag
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy*; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D006801:Humans; D006979:Hyperthermia, Induced; D009367:Neoplasm Staging; D011300:Preoperative Care; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy*; D015996:Survival Rate