title: Late toxicity after short course preoperative radiotherapy and total mesorectal excision for resectable rectal cancer.
abstract: OBJECTIVE
  The late toxicity of short-course preoperative radiotherapy (SCPRT) after total mesorectal excision (TME) in resectable rectal cancer has not been adequately documented. The acute toxicity in a series of 176 consecutive patients has been previously reported. In this study, the late toxicity in the same cohort is presented.
  
  
  METHODS
  Side-effects occurring more than 3 months after the start of SCPRT were graded using the EORTC/RTOG late radiation toxicity system. We performed multivariate analysis to identify associated factors.
  
  
  RESULTS
  Of 176 patients, 15 died within 3 months of SCPRT and five patients were lost to follow-up. One hundred and fifty-six patients were assessable at a median follow-up interval of 41 months: severe (grade 3-4) toxicity was seen in 20 patients (13%), of which 13 were gastrointestinal (8%); three urological (2%); three thromboembolic (2%), and one musculoskeletal (1%). On multivariate analysis, abdomino-perineal (AP) resection (P < 0.02) was associated with a lower risk of grade 3-4 toxicity.
  
  
  CONCLUSIONS
  In this retrospective study, the rate of late grade 3-4 toxicity after SCPRT and TME was 13%. Although AP resection seems to be associated with a lower incidence of late toxicity, this could be counterbalanced by the impact of a stoma on quality of life. These factors should be considered when determining the optimal management of resectable rectal cancers.
authors.affiliation: The Cancer Centre at the Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: M
authors.initials: M
authors.lastname: King
authors.forename: S
authors.initials: S
authors.lastname: Tolan
authors.forename: S
authors.initials: S
authors.lastname: Giridharan
authors.forename: C
authors.initials: C
authors.lastname: McConkey
authors.forename: A
authors.initials: A
authors.lastname: Hartley
authors.forename: J I
authors.initials: JI
authors.lastname: Geh
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011878:Radiotherapy / Q000009:adverse effects; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery*; D012189:Retrospective Studies