title: Preoperative radiotherapy combined with intraoperative radiotherapy improve results of total mesorectal excision in patients with T3 rectal cancer.
abstract: OBJECTIVE
  The survival advantage of preoperative radiotherapy in patients with rectal cancer is still a matter of debate, because its incremental benefit in the total mesorectal excision setting is unclear. This study was designed to evaluate early and long-term results of preoperative radiotherapy plus intraoperative radiotherapy in a homogeneous population of T3 middle and lower rectal cancer patients submitted to total mesorectal excision.
  
  
  METHODS
  A series of 113 patients with middle and lower T3 rectal cancer consecutively submitted to total mesorectal excision at a single surgical unit from 1991 to 1997 were divided into two groups according to type of neoadjuvant treatment: preoperative radiotherapy (38 Gy) plus intraoperative radiotherapy (10 Gy; n = 69), and no preoperative treatment (total mesorectal excision; n = 44). Standard statistical analyses were used to evaluate early (downstaging, intraoperative factors, hospital morbidity, and mortality rates) and long-term results (recurrence and survival).
  
  
  RESULTS
  Overall, 68.2 percent of patients were downstaged by the preoperative regimens (T0 specimens in 3 cases). Postoperative complications were comparable in the two groups. Five-year, disease-specific survival was 81.4 and 58.1 percent in preoperative radiotherapy plus intraoperative radiotherapy group and total mesorectal excision group, respectively (P = 0.052). Corresponding figures for disease-free survival were 73.1 and 57.2 percent in the two groups, respectively (P = 0.096). The rates of local recurrence at five years were 6.6 and 23.2 percent in preoperative radiotherapy plus intraoperative radiotherapy and total mesorectal excision groups, respectively (P = 0.017).
  
  
  CONCLUSIONS
  Preoperative radiotherapy plus intraoperative radiotherapy associated with total mesorectal excision reduce local recurrence rate and improve survival in T3 rectal cancer compared with total mesorectal excision alone.
authors.affiliation: Department of Surgical Sciences--Digestive Surgery Unit, Catholic University, School of Medicine, Rome, Italy. fpacelli@rm.unicatt.it
authors.forename: Fabio
authors.initials: F
authors.lastname: Pacelli
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Giorgio
authors.forename: Valerio
authors.initials: V
authors.lastname: Papa
authors.forename: Antonio Pio
authors.initials: AP
authors.lastname: Tortorelli
authors.forename: Marcello
authors.initials: M
authors.lastname: Covino
authors.forename: Carlo
authors.initials: C
authors.lastname: Ratto
authors.forename: Maurizio
authors.initials: M
authors.lastname: Bossola
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Valentini
authors.forename: Luigi
authors.initials: L
authors.lastname: Sofo
authors.forename: Francesco
authors.initials: F
authors.lastname: Miccichè
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: Gambacorta
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Doglietto
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D009367:Neoplasm Staging; D011300:Preoperative Care; D012004:Rectal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome