title: Long-term results of high-dose extracorporeal and endocavitary radiation therapy followed by abdominoperineal resection for distal rectal cancer.
abstract: OBJECTIVE
  To examine the complications, local effects, survival, and prognostic factors of preoperative high-dose radiation therapy in patients with advanced carcinomas of the distal rectum.
  
  
  METHODS
  Forty-one patients with tethered or fixed rectal cancer located a median distance of 3.0 cm from the anal verge were treated with extracorporeal and endocavitary radiation therapy (70 Gy), followed 2 weeks later by abdominoperineal resection (APR).
  
  
  RESULTS
  This combined radiotherapy achieved acceptable results. Postoperative complications developed in 18 patients (43.9%), 10 (24.3%) of which involved perineal dehiscence. Two patients (4.8%) suffered more than grade 3 toxicity. Destructive changes were histologically confirmed in all specimens, and there were four (9.8%) sterile specimens. Recurrence developed in 11 patients and there were 6 cancer-related deaths. Among six cases of local recurrence, three were found just outside of the radiation field. The 5-year survival and disease-free survival rates were 82.9% and 71.8%, respectively. Multivariate analysis revealed that nodal involvement was the sole independent prognostic factor for survival. Sexual function was maintained in the most recent patients who underwent APR with autonomic nerve-preserving surgery.
  
  
  CONCLUSIONS
  Although the original aim of our treatment focused on curability, this combination therapy may be an option for selected patients, because of potential prevention of local recurrence, relatively low morbidity, and promising autonomic nerve function.
authors.affiliation: First Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara -8522, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Ishikawa
authors.forename: Hisao
authors.initials: H
authors.lastname: Fujii
authors.forename: Fumikazu
authors.initials: F
authors.lastname: Koyama
authors.forename: Tomohide
authors.initials: T
authors.lastname: Mukogawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Matsumoto
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Morita
authors.forename: Michiaki
authors.initials: M
authors.lastname: Hata
authors.forename: Seiji
authors.initials: S
authors.lastname: Terauchi
authors.forename: Toyoki
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakao
authors.forename: Tohru
authors.initials: T
authors.lastname: Nishikawa
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yoshimura
authors.forename: Hajime
authors.initials: H
authors.lastname: Ohishi
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Nakajima
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D002277:Carcinoma / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012004:Rectal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D016896:Treatment Outcome