title: Sphincter preservation in four consecutive phase II studies of preoperative chemoradiation: analysis of 247 T3 rectal cancer patients.
abstract: OBJECTIVE
  To evaluate the impact of preoperative chemoradiation on sphincter preservation in patients with low-medium locally advanced resectable rectal cancer treated by four chemoradiation schedules.
  
  
  METHODS
  Between 1990 and 2002, 247 patients were treated according to four schedules of chemoradiotherapy: FUMIR (5-fluorouracil, mitomycin, external beam radiotherapy 37.8 Gy), PLAFUR (cisplatinum, 5-fluorouracil, external beam radiotherapy 50.4 Gy),TOMRT (raltitrexed, external beam radiotherapy 50.4 Gy), and TOMOXRT (raltitrexed, oxaliplatin, external beam radiotherapy 50.4 Gy). Four to five weeks after chemoradiation, patients were restaged and surgery was performed 2-3 weeks later.
  
  
  RESULTS
  Overall, the sphincter-saving surgery was performed in 82.5% of patients. In patients candidate to an abdominoperineal resection before chemoradiaton (distance tumor-anorectal ring, < 30 mm) a sphincter-saving surgery was possible in 58% of cases: 44% (FUMIR), 52% (PLAFUR), 63% (TOMRT), 76% (TOMOXRT) (P < 0.017). The involved surgeons kept the same surgical criteria in performing sphincter-saving surgery. After chemoradiation, patients with tumor location still between 0 and 30 mm received sphincter-saving surgery according to the protocols: 33% (FUMIR), 42% (PLAFUR), 50% (TOMRT), 64% (TOMOXRT) (P = 0.066).
  
  
  CONCLUSIONS
  Even though the surgeons' skill in performing sphincter-saving surgery could be improved with time, the high rate of this procedure in the latest schedules suggests an impact of the new drugs in promoting tumor downsizing and therefore sphincter-saving surgery.
authors.affiliation: Radiation Therapy Department, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: Gambacorta
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Valentini
authors.forename: Claudio
authors.initials: C
authors.lastname: Coco
authors.forename: Alberto
authors.initials: A
authors.lastname: Manno
authors.forename: Giovanni B
authors.initials: GB
authors.lastname: Doglietto
authors.forename: Carlo
authors.initials: C
authors.lastname: Ratto
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cosimelli
authors.forename: Francesco
authors.initials: F
authors.lastname: Miccichè
authors.forename: Francesca
authors.initials: F
authors.lastname: Maurizi
authors.forename: Luca
authors.initials: L
authors.lastname: Tagliaferri
authors.forename: Giovanna
authors.initials: G
authors.lastname: Mantini
authors.forename: Mario
authors.initials: M
authors.lastname: Balducci
authors.forename: Giuseppe
authors.initials: G
authors.lastname: La Torre
authors.forename: Brunella
authors.initials: B
authors.lastname: Barbaro
authors.forename: Aurelio
authors.initials: A
authors.lastname: Picciocchi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*