title: Recent advances in the treatment and outcome of locally advanced rectal cancer.
abstract: OBJECTIVE
  To compare the outcomes of treatment of locally advanced rectal cancer of the early era (1975-1990) with those of the late era (1991-1997).
  
  
  BACKGROUND
  Preoperative therapy has been used in locally advanced rectal cancer to preserve sphincter function, decrease local recurrence, and improve survival. At the University of Florida, preoperative radiation has been used since 1975, and it was combined with chemotherapy beginning in 1991.
  
  
  METHODS
  The records of 328 patients who underwent preoperative radiation or chemoradiation followed by complete resection for locally advanced rectal cancer defined as tethered, annular, or fixed tumors were reviewed. The clinicopathologic characteristics, adjuvant treatment administered, surgical procedures performed, and local recurrence-free and overall survival rates were analyzed.
  
  
  RESULTS
  There were 219 patients in the early era and 109 in the late era. No significant differences were seen in patients (age, gender, race) or tumor characteristics (mean distance from the anal verge, annularity, fixation). Preoperative radiation regimens were radiobiologically comparable. No patient in the early era received preoperative chemotherapy, compared with 64 in the late era. Of those receiving any pre- or postoperative chemotherapy, three patients received chemotherapy in the early era, compared with 76 in the late era. Sphincter-preserving procedures increased from 13% in the early era to 52% in the late era. Pathologic downstaging for depth of invasion increased from 42% to 58%, but lymph node negativity remained similar. The 1-, 3-, and 5-year local recurrence-free survival rates were comparable. However, in the late era, 1-, 3-, and 5-year overall survival rates improved significantly compared with those of the early era, and also compared with each of the preceding 5-year intervals.
  
  
  CONCLUSIONS
  The addition of a chemotherapy regimen to preoperative radiation therapy improves survival over radiation therapy alone. Likewise, an improvement in downstaging is associated with an increase in sphincter-preserving procedures.
authors.affiliation: Department of Surgery, College of Medicine, University of Florida, Gainesville, USA.
authors.forename: J N
authors.initials: JN
authors.lastname: Vauthey
authors.forename: R W
authors.initials: RW
authors.lastname: Marsh
authors.forename: R A
authors.initials: RA
authors.lastname: Zlotecki
authors.forename: E K
authors.initials: EK
authors.lastname: Abdalla
authors.forename: C C
authors.initials: CC
authors.lastname: Solorzano
authors.forename: E J
authors.initials: EJ
authors.lastname: Bray
authors.forename: M E
authors.initials: ME
authors.lastname: Freeman
authors.forename: G Y
authors.initials: GY
authors.lastname: Lauwers
authors.forename: P S
authors.initials: PS
authors.lastname: Kubilis
authors.forename: W M
authors.initials: WM
authors.lastname: Mendenhall
authors.forename: E M
authors.initials: EM
authors.lastname: Copeland
mesh_terms: D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D012004:Rectal Neoplasms / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate; D016896:Treatment Outcome