title: Long-term results after neoadjuvant radiochemotherapy for locally advanced resectable extraperitoneal rectal cancer.
abstract: OBJECTIVE
  This study was designed to evaluate long-term outcome in locally advanced resectable extraperitoneal rectal cancer treated by preoperative radiochemotherapy.
  
  
  METHODS
  Eighty-three consecutive patients who developed locally advanced resectable extraperitoneal rectal cancer underwent preoperative concomitant radiochemotherapy followed by surgery, including total mesorectal excision.
  
  
  RESULTS
  Median follow-up was 108 (range, 10-169) months. The living patients underwent complete follow-up of, at least, nine years. Fourteen patients developed local recurrence. The time to detection was longer than two years in eight cases and longer than five years in four. Twenty-one patients developed metastases, 19 within the first five years from surgery. At the univariate analysis, clinical stage at presentation, lymph node involvement at clinical restaging after neoadjuvant therapy, and pT and pN stage were found positively correlated to the incidence of metastases. At the multivariate analysis, the only factors which confirmed a positive correlation were pT stage and pN stage. The actuarial overall survival at five, seven, and ten years was 75.5, 67.8, and 60.4 percent, respectively. The same figures for cancer-related survival were 77.9, 70, and 65.8 percent. At the univariate analysis, factors directly correlated with worse survival were: TNM stage at clinical restaging after neoadjuvant therapy (in particular lymph node involvement) pTNM, pT, and pN. At the multivariate analysis the only factors that confirmed a correlation with worse survival were pTNM, pT, and pN.
  
  
  CONCLUSIONS
  Long- term follow-up allows to individuate 28 percent of all local relapses after the first five years from surgery. Postoperative stage is highly predictive of prognosis.
authors.affiliation: Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Coco
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Valentini
authors.forename: Alberto
authors.initials: A
authors.lastname: Manno
authors.forename: Claudio
authors.initials: C
authors.lastname: Mattana
authors.forename: Alessandro
authors.initials: A
authors.lastname: Verbo
authors.forename: Numa
authors.initials: N
authors.lastname: Cellini
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: Gambacorta
authors.forename: Marcello
authors.initials: M
authors.lastname: Covino
authors.forename: Giovanna
authors.initials: G
authors.lastname: Mantini
authors.forename: Francesco
authors.initials: F
authors.lastname: Miccichè
authors.forename: Giorgio
authors.initials: G
authors.lastname: Pedretti
authors.forename: Luigi
authors.initials: L
authors.lastname: Petito
authors.forename: Gianluca
authors.initials: G
authors.lastname: Rizzo
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cosimelli
authors.forename: Fabrizio Ambesi
authors.initials: FA
authors.lastname: Impiombato
authors.forename: Aurelio
authors.initials: A
authors.lastname: Picciocchi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D012004:Rectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D015996:Survival Rate
chemical_list: D016685:Mitomycin; D005472:Fluorouracil