title: Prognostic significance of adverse events associated with preoperative radiotherapy for rectal cancer.
abstract: OBJECTIVE
  Adverse events may occur in patients receiving preoperative radiotherapy (PRT) for rectal cancers. The aim of this study is to clarify the clinical and pathological features of the patients with PRT-related adverse events, and the significance of the adverse events on the clinical outcome.
  
  
  METHODS
  Seventy-five patients with T3 or T4 low rectal cancers curatively resected following PRT were studied. Thirty-one patients received radiotherapy, and 44 patients received chemoradiotherapy with tegafur-uracil and leucovorin. The total radiation dose was 50-50.4 Gy given in 25-28 fractions and the operation was performed 4-8 weeks after PRT. PRT-related adverse events were graded in accordance with the Common Terminology Criteria for Adverse Events v3.0.
  
  
  RESULTS
  The most frequent adverse events were leukocytopenia and diarrhea, observed in 12% and 24% of patients, respectively. The majority of the leukocytopenia and diarrhea was grade 1-2 toxicity. Women experienced leukocytopenia more frequently than men (28% vs. 7%, p = 0.0317); however, no other predisposing factor for adverse events was recognized. Patients with leukocytopenia or diarrhea showed a better 5-year relapse-free survival rate than those without (94 ± 5% vs. 49 ± 9%, p = 0.00054), and the presence of these adverse events was an independent prognostic factor in a multivariate analysis.
  
  
  CONCLUSIONS
  The presence of leukocytopenia or diarrhea was an independent predictor of a fair prognosis after curative operation following PRT, and thus these adverse events seem not to discourage oncologists and patients from considering PRT for rectal cancers.
authors.affiliation: Department of Surgery, Teikyo University, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan. sochan31@hotmail.com
authors.forename: Soichiro
authors.initials: S
authors.lastname: Ishihara
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Watanabe
authors.forename: Takuya
authors.initials: T
authors.lastname: Akahane
authors.forename: Ryu
authors.initials: R
authors.lastname: Shimada
authors.forename: Atsushi
authors.initials: A
authors.lastname: Horiuchi
authors.forename: Hajima
authors.initials: H
authors.lastname: Shibuya
authors.forename: Tamuro
authors.initials: T
authors.lastname: Hayama
authors.forename: Hideki
authors.initials: H
authors.lastname: Yamada
authors.forename: Keijiro
authors.initials: K
authors.lastname: Nozawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Igaki
authors.forename: Keiji
authors.initials: K
authors.lastname: Matsuda
mesh_terms: D000368:Aged; D003967:Diarrhea / Q000209:etiology; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007970:Leukopenia / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011379:Prognosis; D011878:Radiotherapy / Q000009:adverse effects*; D012004:Rectal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D012008:Recurrence