title: Preoperative bi-fractionated accelerated radiation therapy for combined treatment of locally advanced rectal cancer in a consectutive series of unselected patients.
abstract: BACKGROUND
  although preoperative RT (Radiation Therapy) is becoming the preferred approach for combined treatment of locally advanced rectal adenocarcinoma, no regimen can be now considered as a standard. Since the toxicity of preoperative RT isn't yet completely known, and the advantages of preoperative RT could be counterbalanced by increased postoperative morbidity and mortality, a monocentre series of preoperative bifractionated accelerated RT was retrospectively reviewed to clarify toxicity and outcomes after a prolonged follow up.
  
  
  METHODS
  patients were screened following these eligibility criteria: histology-proven adenocarcinoma of the rectum; distal tumour extent at 12 cm or less from the anal verge; clinical stage T3-4/anyN, or anyT/N1-2; ECOG Performance Status 0-2. A total dose of 41.6 Gy (26 twice daily fractions of 1.6 Gy) was delivered. Surgery was carried out 17 +/- 2 days after RT completion, adopting the total mesorectal excision technique.
  
  
  RESULTS
  24 men and 23 women were enrolled; median age was 55 years (r.: 39-77). Twenty-eight patients were stage II and 19 stage III. 9 patients suffered from a recurrent tumour. 2 patients experienced a severe grade 4 gastrointestinal toxicity (a colo-vaginal fistula and an intestinal obstruction, both successfully treated). Operative mortality was nil; postoperative early complications occurred in 13 cases; mean length of hospital stay was 15 days. After a mean follow up of 44 months (r.: 18-84) 8 patients had deceased for recurrent disease, 15 were alive with a disease progression (2 pelvic recurrences and 13 pure distant deposits) and 24 were alive, without disease. The 5-year actuarial overall survival was 74.2%, the disease-free survival 62.9% and the regional control rate 84.7%. Long-term complications included 1 case of radiation enteritis requiring surgery, 2 cases of anastomotic stricture and 3 cases of bladder incontinence.
  
  
  CONCLUSIONS
  bifractionated accelerated RT administered in the preoperative setting to patients bearing locally advanced rectal cancer is reliable and safe, as its immediate and late toxicity (mainly infectious) is acceptably low and long-term survivals are achievable. These findings support the increasing use of preoperative RT for treatment of this malignancy in experienced centres. Ongoing multicentric trials are expected to address still unsolved issues, including the benefit of CT adjunct to preoperative RT.
authors: Dept. of General Surgery-European Institute of Oncology and University of Milano, Via Ripamonti, 435, Italy.
authors: Roberto
authors: R
authors: Biffi
authors: Dept. of Radiotherapy-European Institute of Oncology and University of Milano, Via Ripamonti, 435, Italy.|Dept. of Radiotherapy, Institute Gustav Roussy, Villejuif, France.
authors: Hugo
authors: H
authors: Marsiglia
authors: Dept. of Radiotherapy-European Institute of Oncology and University of Milano, Via Ripamonti, 435, Italy.
authors: Barbara Jereczek
authors: BJ
authors: Fossa
authors: Dept. of Radiotherapy-European Institute of Oncology and University of Milano, Via Ripamonti, 435, Italy.
authors: Maria Cristina
authors: MC
authors: Leonardi
authors: Dept. of Radiotherapy-European Institute of Oncology and University of Milano, Via Ripamonti, 435, Italy.
authors: Domenico
authors: D
authors: Cante
authors: Dept. of Radiotherapy-European Institute of Oncology and University of Milano, Via Ripamonti, 435, Italy.
authors: Roberta
authors: R
authors: Lazzari
authors: Dept. of General Surgery-European Institute of Oncology and University of Milano, Via Ripamonti, 435, Italy.
authors: Antonio
authors: A
authors: Chiappa
authors: Dept. of General Surgery-European Institute of Oncology and University of Milano, Via Ripamonti, 435, Italy.
authors: Sabine
authors: S
authors: Cenciarelli
authors: Dept. of General Surgery-European Institute of Oncology and University of Milano, Via Ripamonti, 435, Italy.
authors: Bruno
authors: B
authors: Andreoni
authors: Dept. Of Oncolgy-European Institute of Oncology-Milano, Via Ripamonti, 435. Italy.
authors: Maria Giulia
authors: MG
authors: Zampino
authors: Dept. of Radiotherapy-European Institute of Oncology and University of Milano, Via Ripamonti, 435, Italy.
authors: Roberto
authors: R
authors: Orecchia