title: Postoperative chemoradiotherapy in rectal cancer. Late results of a pilot study.
abstract: OBJECTIVE
  It has recently been proven that postoperative radiotherapy combined with fluorouracil showed an increase of survival and local control in patients with rectal cancer. However, hematological and intestinal toxicity also increased. Experimental and clinical studies showed an increased radiation effect with an acceptable toxicity by delivering drug via a continuous intravenous infusion.
  
  
  METHODS
  From 1988 to 1998, 80 patients radically operated on for stages B2-C rectal cancer were irradiated with 3 fractions of 100 cGy per day to a total dose of 5,600 cGy. 34 out of these 80 patients underwent postoperative radiotherapy alone and 46 received radiotherapy combined with concomitant protracted infusion of fluorouracil at doses of 250 mg/m2 per day.
  
  
  RESULTS
  After a median follow-up of 54 months, the 5-year overall and disease-free survival were 59% and 54%, respectively, in the combined modality group, as compared to 42% and 34%, respectively, in the radiation alone group. The differences were not significant, but the incidence of local relapse and patients' survival showed a better trend for combined approach.
  
  
  CONCLUSIONS
  The data from international literature are in favor of a combined approach, both in preoperative and postoperative treatment of advanced rectal cancer. Adjuvant therapy must be re-evaluated in trials using total mesorectal excision as the standard operative technique.
authors.affiliation: Department of Surgical Sciences, General Surgery 1, San Camillo Hospital, Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Tersigni
authors.forename: Luciano
authors.initials: L
authors.lastname: Alessandroni
authors.forename: Giorgio
authors.initials: G
authors.lastname: Arcangeli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Baiano
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Marini
authors.forename: Adriana
authors.initials: A
authors.lastname: Micheli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Sorgi
mesh_terms: D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D003082:Colectomy / Q000379:methods; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D020714:Maximum Tolerated Dose; D008875:Middle Aged; D010865:Pilot Projects; D011336:Probability; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D005472:Fluorouracil