title: Prognostic implications of downstaging following preoperative radiation therapy for operable T3-T4 rectal cancer.
abstract: OBJECTIVE
  To evaluate the prognostic value of tumor downstaging after preoperative radiation for resectable rectal cancer.
  
  
  METHODS
  Eighty-eight patients with non-metastatic resectable rectal cancers (76 T3 and 12 T4) were treated with preoperative irradiation. Median dose was 40 Gy (30-46 Gy) delivered over 32 days (range 11-40). Seventeen patients received preoperative chemotherapy, two courses of 5-fluorouracil (5FU) 350 mg/m2/day and folinic acid 20 mg/m2/day; 5 days per week during the first and fifth weeks of radiotherapy. Surgery was performed with a mean delay of 46 days after completion of irradiation and included 66 abdominoperineal resections and 22 anal sphincter-preserving procedures. Postoperative chemotherapy was administered in 44 patients.
  
  
  RESULTS
  Histological tumor stages were: complete histological response in 7%, pT2N0 in 19%, pT3N0 in 46%, and pT2-3N1 in 28%. Tumor downstaging occurred in 26%. No predictive factor of downstaging was statistically significant. The median follow-up was 33 months. The 3- and 5-year cancer-specific survival rates were 100% for the pT0N0 and pT2N0, respectively, 89% and 68% for pT3N0, and 64% and 0% for pT2T3N1. After preoperative irradiation, the pathological tumor stages remained a prognostic factor. Patients with downstaging (pT0T2N0) had significantly higher cancer-specific survival rates than the group without downstaging: 100% and 80% at 3 years, and 100% and 45% at 5 years; respectively (p = 0.011). The 3- and 5-year recurrence free-survival rates were 94% for the group with downstaging and 56% and 50%, respectively, for the group without downstaging (p = 0.002).
  
  
  CONCLUSIONS
  Downstaging after preoperative irradiation in this retrospective study results in an improvement in local control and survival.
authors.affiliation: Department of Medical Oncology, Centre Alexis Vautrin, Vandoeuvre-les-Nancy, France. mc.kaminsky@nancy.fnclcc.fr
authors.forename: M C
authors.initials: MC
authors.lastname: Kaminsky-Forrett
authors.forename: T
authors.initials: T
authors.lastname: Conroy
authors.forename: E
authors.initials: E
authors.lastname: Luporsi
authors.forename: D
authors.initials: D
authors.lastname: Peiffert
authors.forename: M
authors.initials: M
authors.lastname: Lapeyre
authors.forename: P
authors.initials: P
authors.lastname: Boissel
authors.forename: F
authors.initials: F
authors.lastname: Guillemin
authors.forename: P
authors.initials: P
authors.lastname: Bey
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D012004:Rectal Neoplasms / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery; D012189:Retrospective Studies; D016019:Survival Analysis