title: Chemoradiation instead of surgery to treat mid and low rectal tumors: is it safe?
abstract: BACKGROUND
  The main treatment for rectal carcinoma is surgery. Preoperative chemoradiation (CRT) is advocated to reduce local recurrence and improve resection of mid and low tethered rectal tumors.
  
  
  METHODS
  Fifty-two patients with mid or low rectal tumors underwent CRT (external beam radiation plus 5-fluorouracil plus folinic acid). Patients who had low rectal tumors with complete response (CR) were not submitted to surgical treatment. All other patients were submitted to surgery, independently of the response. Mean follow-up was 32.1 months.
  
  
  RESULTS
  Five-year overall survival was 60.5%. Clinical evaluation after CRT showed CR in 10 cases (19.2%), all low tumors; incomplete response (>50%) in 21 (40.4%); and no response (<50%) in 19 (36.6%). Among the 10 cases with CR, 8 presented with local recurrence within 3.7 to 8.8 months. Two patients were not submitted to surgery and are still alive without cancer after 37 and 58 months. Thirty-nine patients had radical surgery. Seven had local recurrences after CRT plus surgery (17.9%). Overall survival was negatively affected by lymph node metastases (P =.017) and perineural invasion (P =.026).
  
  
  CONCLUSIONS
  Exclusive CRT approach is not safe to treat patients with low infiltrative rectal carcinoma.
authors.affiliation: Pelvic Surgery Department, A. C. Camargo Cancer Hospital, Antonio Prudente Foundation, São Paulo, Brazil. wtnakagawa@uol.com.br
authors.forename: Wilson T
authors.initials: WT
authors.lastname: Nakagawa
authors.forename: Benedito M
authors.initials: BM
authors.lastname: Rossi
authors.forename: Fábio
authors.initials: F
authors.lastname: de O Ferreira
authors.forename: Robson
authors.initials: R
authors.lastname: Ferrigno
authors.forename: Waldec J
authors.initials: WJ
authors.lastname: David Filho
authors.forename: Inês N
authors.initials: IN
authors.lastname: Nishimoto
authors.forename: Rene A C
authors.initials: RA
authors.lastname: Vieira
authors.forename: Ademar
authors.initials: A
authors.lastname: Lopes
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D002955:Leucovorin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011879:Radiotherapy Dosage; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D015996:Survival Rate
chemical_list: D000964:Antimetabolites, Antineoplastic; D002955:Leucovorin; D005472:Fluorouracil