title: Oncologic outcomes after neoadjuvant chemoradiation followed by curative resection with tumor-specific mesorectal excision for fixed locally advanced rectal cancer: Impact of postirradiated pathologic downstaging on local recurrence and survival.
abstract: OBJECTIVE
  The purpose of this study was to determine the oncologic outcomes and clinical factors affecting survival in patients who underwent neoadjuvant chemoradiotherapy following tumor specific mesorectal excision for locally advanced, fixed rectal cancer.
  
  
  BACKGROUND
  Neoadjuvant chemoradiation therapy has resulted in significant tumor downstaging, which enhances curative resection and subsequently improves local disease control for rectal cancer. However, oncologic outcomes, according to clinical factors, have not yet been fully understood in locally advanced and fixed rectal cancer.
  
  
  METHODS
  A total of 114 patients who had undergone neoadjuvant chemoradiation for advanced rectal cancer (T3 or T4 and node positive) were investigated retrospectively. Chemotherapy was administered intravenously with 5-FU and leucovorin during weeks 1 and 5 of radiotherapy. The total radiation dose was 5040 cGY in 25 fractions delivered over 5 weeks. Tumor-specific mesorectal excision was done 4 to 6 weeks after the completion of neoadjuvant chemoradiation. Survival and recurrence rates, according to the pathologic stage, were evaluated. Moreover, factors affecting survival were investigated.
  
  
  RESULTS
  The 5-year survival rates according to pathologic stage were: 100% in pathologic complete remission (n = 10), 80% in stage I (n = 23), 56.8% in stage II (n = 34), and 42.3% in stage III (n = 47) (P = 0.0000). Local, systemic, and combined recurrence rates were 11.4%, 22.8%, and 3.5%, respectively. Multivariate analysis showed that the pathologic N stage and operation method were the independent factors affecting survival rate.
  
  
  CONCLUSIONS
  Pathologic complete remission showed excellent oncologic outcomes, and the pathologic N stage was the most important factor for oncologic outcomes.
authors.affiliation: Colorectal Cancer Clinic, Severance Hospital, Yonsei University Medical Center, Yonsei University College of Medicine, Seoul, Korea. namkyuk@yumc.yonsei.ac.kr
authors.forename: Nam Kyu
authors.initials: NK
authors.lastname: Kim
authors.forename: Seung Hyuk
authors.initials: SH
authors.lastname: Baik
authors.forename: Jin Sil
authors.initials: JS
authors.lastname: Seong
authors.forename: Hoguen
authors.initials: H
authors.lastname: Kim
authors.forename: Jae Kyung
authors.initials: JK
authors.lastname: Roh
authors.forename: Kang Young
authors.initials: KY
authors.lastname: Lee
authors.forename: Seung Kook
authors.initials: SK
authors.lastname: Sohn
authors.forename: Chang Hwan
authors.initials: CH
authors.lastname: Cho
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D009367:Neoplasm Staging; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome