title: Effect of timing of surgery on survival after preoperative hyperfractionated accelerated radiotherapy (HART) for locally advanced rectal cancer (LARC): is it a matter of days?
abstract: We intend to analyse retrospectively whether the time interval ("gap duration" = GD) between preoperative radiotherapy and surgery in locally advanced rectal cancer (LARC) has an impact on overall survival (OS), cancer specific survival (CSS), disease free survival (DFS) and local control (LC). Two hundred seventy nine patients with LARC were entered in Trial 93-01 (hyperfractionated accelerated radiotherapy 41.6 Gy/26 Fx BID) shortly followed by surgery. From these 250 patients are fully assessable. The median GD of 5 days was used as a discriminator. The median follow-up for all patients was 39 months. GD > 5 days was a significant discriminator for actuarial 5-years OS (69% vs 47%, p = 0.002), CSS (82% vs 57%, p = 0.0007), DFS (62% vs 41%, p = 0.0003) but not for LC (93% vs 90%, p = non-significant). In multivariate analysis, the following factors independently predict outcome; for OS: age, GD, circumferential margin (CM) and nodal stage (ypN); for CSS: GD, ypN and vascular invasion (VI); for DFS: CEA, distance to anal verge, GD, ypN and VI; for LC: CM only. Gap duration predicts survival outcome but not local control. The patients submitted to surgery after a median delay of more than 5 days had a significantly better outcome.
authors.affiliation: Department of Radiation Oncology, Centre Hospitalier Universitaire Liège, Belgique. pcoucke@chu.ulg.ac.be
authors.forename: Philippe A
authors.initials: PA
authors.lastname: Coucke
authors.forename: Markus
authors.initials: M
authors.lastname: Notter
authors.forename: Maurice
authors.initials: M
authors.lastname: Matter
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Fasolini
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Calmes
authors.forename: Rolph
authors.initials: R
authors.lastname: Schlumpf
authors.forename: Norbert
authors.initials: N
authors.lastname: Schwegler
authors.forename: Bernhard
authors.initials: B
authors.lastname: Stamm
authors.forename: Hu
authors.initials: H
authors.lastname: Phuoc Do
authors.forename: Hanifa
authors.initials: H
authors.lastname: Bouzourene
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors