title: Long-term efficacy of preoperative radiotherapy for locally advanced low rectal cancer.
abstract: OBJECTIVE
  The purpose of this study was to assess the long-term efficacy of preoperative radiotherapy for locally advanced low rectal cancer.
  
  
  METHODS
  Between April 1990 and June 2005, all patients who underwent surgery for low rectal cancer with a pretreatment diagnosis of T3 or resectable T4 without distant metastasis were enrolled. The total dose of radiation was 45 Gy. Patients with a partial or complete response were defined as radiotherapy responders (RT-R) and the others as radiotherapy non-responders (RT-NR). Patients who did not receive radiotherapy were termed the non-radiotherapy group (NRT). The endpoint of this study was overall survival and local and/or distant metastasis.
  
  
  RESULTS
  There were 24 patients in RT-R, 26 in RT-NR, and 40 in NRT. Gastrointestinal complications were commonly observed in all groups. RT-R had a significantly higher incidence of genitourinary complications. Five-year overall survival rate was 79.6% in RT-R, 58.9% in RT-NR, and 58.8% in NRT. The difference was significant in favor of RT-R over the others (P=0.015, 0.024, respectively). Five-year local recurrence-free survival rate was 100% in RT-R, 81.5% in RT-NR, and 74.9% in NRT. RT-R had significantly improved local control compared with the others (P=0.034, 0.021, respectively). Five-year distant metastasis-free survival was not statistically different among all groups.
  
  
  CONCLUSIONS
  Survival benefit of preoperative radiotherapy was limited to responders. Considering the increased risk of adverse effects, identification of predictors of radiosensitivity is required in order to provide the most suitable treatment for individual patients.
authors: Department of Surgery, Jichi Medical University Omiya Medical Center, 1-847, Amanumacho, Omiya, Saitama-shi, Saitama 330-8503, Japan. tsujinakas@omiya.jichi.ac.jp
authors: Shingo
authors: S
authors: Tsujinaka
authors: Yutaka J
authors: YJ
authors: Kawamura
authors: Fumio
authors: F
authors: Konishi
authors: Hiroyuki
authors: H
authors: Aihara
authors: Takafumi
authors: T
authors: Maeda
authors: Ken
authors: K
authors: Mizokami
mesh_terms: D000328:Adult; D000368:Aged; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011829:Radiation Dosage; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome
references: J Clin Oncol. 2006 Oct 1;24(28):4620-5
references: 17008704
references: Eur J Surg Oncol. 2006 Feb;32(1):55-64
references: 16324817
references: J Natl Cancer Inst. 2000 Feb 2;92 (3):205-16
references: 10655437
references: N Engl J Med. 1997 Apr 3;336(14 ):980-7
references: 9091798
references: Arch Surg. 1998 Aug;133(8):894-9
references: 9711965
references: N Engl J Med. 2001 Aug 30;345(9):638-46
references: 11547717
references: J Natl Cancer Inst. 1988 Mar 2;80(1):21-9
references: 3276900
references: N Engl J Med. 2006 Sep 14;355(11):1114-23
references: 16971718
references: Dis Colon Rectum. 2006 Nov;49(11):1663-72
references: 17041749
references: Br J Surg. 2003 Aug;90(8):996-8
references: 12905554
references: JAMA. 2000 Aug 23-30;284(8):1008-15
references: 10944647
references: Clin Colorectal Cancer. 2006 Mar;5(6):413-21
references: 16635280
references: J Clin Oncol. 2005 Dec 1;23(34):8697-705
references: 16314629
references: Dis Colon Rectum. 2000 Oct;43(10 Suppl):S59-68
references: 11052480
references: JAMA. 1990 Sep 19;264(11):1444-50
references: 2202842
references: Cancer Res. 2006 Apr 1;66(7):3370-4
references: 16585155
references: Br J Surg. 2006 Oct;93(10):1215-23
references: 16983741
references: Dis Colon Rectum. 1993 Jun;36(6):564-72
references: 8500374
references: N Engl J Med. 2004 Oct 21;351(17):1731-40
references: 15496622
references: Dis Colon Rectum. 2006 Mar;49(3):302-10
references: 16456638
references: J Clin Oncol. 2005 Sep 1;23(25):6199-206
references: 16135487
references: J Clin Oncol. 1999 Aug;17(8):2396
references: 10561302
references: N Engl J Med. 1985 Jun 6;312(23 ):1465-72
references: 2859523
references: Dis Colon Rectum. 2001 Sep;44(9):1274-80
references: 11584199
references: Lancet. 2001 Oct 20;358(9290):1291-304
references: 11684209