title: Preoperative radiotherapy alone or combined with chemotherapy followed by transanal excision for rectal adenocarcinoma.
abstract: OBJECTIVE
  To evaluate the efficacy of preoperative radiotherapy (RT) and chemoradiation (CRT) followed by transanal excision (TAE) for rectal adenocarcinoma.
  
  
  METHODS
  Thirty-two patients were treated between July 1988 and April 2004 and followed from 2 to 123 months (median, 27 months).
  
  
  RESULTS
  The 3-year outcomes were: locoregional control, 79%; distant metastasis-free survival, 80%; cause-specific survival, 88%; and overall survival, 75%. Outcomes were better for patients with T1-T2 tumors and those who experienced a complete response to preoperative RT or CRT. Two patients (6%) had chronic RT proctitis after treatment.
  
  
  CONCLUSIONS
  A select subset of patients with T2/T3 tumors will experience similar outcomes after preoperative RT or CRT and TAE compared with radical proctectomy. Reliably predictive clinicopathologic features to define this subgroup would best be elicited in the context of large prospective randomized trials, as would the optimal combination and schedule of systemic agents delivered in conjunction with preoperative RT. Patients who experience a complete response (cCR) after preoperative CRT are excellent candidates for TAE; those with less than a cCR have a less-favorable prognosis and are probably better treated with a low anterior resection or abdominal-perineal resection.
authors.affiliation: Department of Radiation Oncology, University of Florida, Gainesville, FL 32510-0385, USA.
authors.forename: Kenyon
authors.initials: K
authors.lastname: Meadows
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Morris
authors.forename: W Robert
authors.initials: WR
authors.lastname: Rout
authors.forename: Robert A
authors.initials: RA
authors.lastname: Zlotecki
authors.forename: Steven N
authors.initials: SN
authors.lastname: Hochwald
authors.forename: Robert D
authors.initials: RD
authors.lastname: Marsh
authors.forename: Edward M
authors.initials: EM
authors.lastname: Copeland
authors.forename: William M
authors.initials: WM
authors.lastname: Mendenhall
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome