title: Preoperative radiotherapy and local excision of rectal cancer with immediate radical re-operation for poor responders.
abstract: OBJECTIVE
  To report an early analysis of prospective study exploring preoperative radiotherapy and local excision in rectal cancer.
  
  
  METHODS
  Mucosa at tumour edges was tattooed. Patients with cT1-3N0 tumour <3-4 cm were treated with either 5x5Gy+4Gy boost (N=31) or chemoradiation (50.4Gy+5.4Gy boost, 1.8Gy per fraction+5-fluorouracyl and leucovorin; N=13). Thirteen patients from the short-course group were unfit for chemotherapy. The interval from radiation to full-thickness local excision was 6 weeks. The protocol called for conversion to a transabdominal surgery in case of ypT2-3 disease or positive margin.
  
  
  RESULTS
  The postoperative complications requiring hospitalization were recorded in 9% of patients. The rate of pathological complete response was 41%. The rate of patients requiring conversion was 34%; however, 18% actually underwent conversion and the remaining 16% refused or were unfit. During the 14 months of median follow-up, local recurrence was detected in 7% of patients and all underwent salvage surgery. Of 19 patients in whom initially anterior resection was likely, 16% had abdominoperineal resection performed for a conversion or as a rescue procedure.
  
  
  CONCLUSIONS
  Our study suggests that the short-course radiation prior to local excision is a treatment option for high-risk patients.
authors.affiliation: Department of Radiotherapy, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, W.K. Roentgena 5, Warsaw, Poland. bujko@coi.waw.pl
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Bujko
authors.forename: Piotr
authors.initials: P
authors.lastname: Richter
authors.forename: Milena
authors.initials: M
authors.lastname: Kołodziejczyk
authors.forename: Marek P
authors.initials: MP
authors.lastname: Nowacki
authors.forename: Jan
authors.initials: J
authors.lastname: Kulig
authors.forename: Tadeusz
authors.initials: T
authors.lastname: Popiela
authors.forename: Tomasz
authors.initials: T
authors.lastname: Gach
authors.forename: Janusz
authors.initials: J
authors.lastname: Oledzki
authors.forename: Rafał
authors.initials: R
authors.lastname: Sopyło
authors.forename: Wiktor
authors.initials: W
authors.lastname: Meissner
authors.forename: Ryszard
authors.initials: R
authors.lastname: Wierzbicki
authors.forename: Wojciech
authors.initials: W
authors.lastname: Polkowski
authors.forename: Teresa
authors.initials: T
authors.lastname: Kowalska
authors.forename: Grazyna
authors.initials: G
authors.lastname: Stryczyńska
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Paprota
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D012086:Reoperation