title: Role of neoadjuvant treatment in cT3N0M0 rectal cancer.
abstract: BACKGROUND
  The aim of the study was to evaluate the pathological response (pTNM), local relapse and overall survival (OS) in clinical T3N0M0 (cT3N0M0) rectal cancer after a neoadjuvant chemoradiotherapy (CHT-RT) with 5-fluorouracil (5-FU) continuous infusion (c.i.) (+/- oxaliplatin) or bolus or capecitabine (an oral fluorpyrimidine). A secondary endpoint was to identify the local relapse rate and OS in those patients also receiving an adjuvant chemotherapy.
  
  
  METHODS
  From January 2000 to January 2006, 48 consecutive cT3N0M0 rectal cancer cases neoadjuvantly treated were retrospectively examined. Variables considered were age, gender, modality of 5-FU administration and tumour site.
  
  
  RESULTS
  Median age was 64 years (range, 22-84 years) and the male:female ratio was 28:20. All the patients received the full course of CHT-RT. Twenty-eight patients received c.i. 5-FU neoadjuvant chemotherapy, 17 received bolus 5-FU administration and 3 patients received capecitabine-based therapy. The mean number of chemotherapy weeks was 4.9 (range, 2-6). A total of 85.4% of patients were operated on without relevant postoperative complications but another 4 are awaiting surgery. Twenty-one patients had a lower (< or = 5 cm from the anal verge) and 27 had a middle rectal lesion (from 6 to 10 cm). In those patients with the lower site of lesion, a sphincter-saving (SS) procedure was achieved in 88.9%. Downstaging was reported in 66.7%. Ninety percent of cases are still free from progression after a median follow-up of 22.1 months; 7.5% are dead.
  
  
  CONCLUSIONS
  The down-staging, the good level of SS and the disease-free survival (DFS) obtained here suggests that a neoadjuvant therapy may also be useful for stage II rectal cancer at diagnosis. The use of a postoperative chemotherapy should probably be outlined better.
authors.affiliation: Istituto Oncologico Veneto, IRCCS, Oncologia Medica 2, Via Gattamelata 64, 35128 Padova, Italy. laramary@libero.it
authors.forename: Lara Maria
authors.initials: LM
authors.lastname: Pasetto
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Friso
authors.forename: Salvatore
authors.initials: S
authors.lastname: Pucciarelli
authors.forename: Umberto
authors.initials: U
authors.lastname: Basso
authors.forename: Massimo
authors.initials: M
authors.lastname: Rugge
authors.forename: Giulietta
authors.initials: G
authors.lastname: Sinigaglia
authors.forename: Elena
authors.initials: E
authors.lastname: Rossi
authors.forename: Alessia
authors.initials: A
authors.lastname: Compostella
authors.forename: Paola
authors.initials: P
authors.lastname: Toppan
authors.forename: Marco
authors.initials: M
authors.lastname: Agostini
authors.forename: Silvio
authors.initials: S
authors.lastname: Monfardini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D000069287:Capecitabine; D017024:Chemotherapy, Adjuvant; D003841:Deoxycytidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage / Q000009:adverse effects; D000077150:Oxaliplatin; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D055815:Young Adult
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D003841:Deoxycytidine; D000069287:Capecitabine; D005472:Fluorouracil