title: Which patients benefit from preoperative chemoradiotherapy for intermediate staged rectal cancer?
abstract: BACKGROUND
  The aim of this study was to identify subgroups that benefit from preoperative or postoperative chemoradiotherapy (CRT) for rectal cancer of intermediate stage.
  
  
  METHODS
  Between 1999 and 2004, 118 and 177 patients matched with respect to clinical T stage, circumferential tumor extent (= 60% / > 60%), lymph node metastasis, and lymph node size (< 1 cm / ≥ 1 cm), were allocated to preoperative CRT and postoperative CRT, respectively. In preoperative CRT, a total of 45 Gy was delivered with chemotherapy, and then surgery followed. In postoperative CRT, 45-51 Gy was delivered with chemotherapy following primary surgery.
  
  
  RESULTS
  Local recurrence, distant metastasis, disease-free survival, and disease-specific survival were not different between the two schemes. For a circumferential tumor extent of = 60%, local recurrence in preoperative CRT (3.6%) was lower than in postoperative CRT (11.9%) (p = 0.084, hazard ratio (HR) = 0.274, 95% confidence interval (CI) = 0.058-1.032). For a tumor located < 5cm from the anal verge, distant metastasis in preoperative CRT (18.9%) was lower than in postoperative CRT (34.4%) (p = 0.061, HR = 0.444, 95% CI = 0.188- 1.047), and 5-year disease-free survival rates in preoperative and postoperative CRT were 72.0 and 59.0%, respectively (p = 0.078).
  
  
  CONCLUSIONS
  Our findings suggest that preoperative CRT might be appropriate in rectal cancer involving the limited circumferential lumen and located in the low rectum. However, further prospective studies are required.
authors.affiliation: Department of Radiation Oncology, Korea University Medical Center, Korea University School of Medicine, Seoul, Korea.
authors.forename: Won Sup
authors.initials: WS
authors.lastname: Yoon
authors.forename: Won
authors.initials: W
authors.lastname: Park
authors.forename: Doo Ho
authors.initials: DH
authors.lastname: Choi
authors.forename: Yong Chan
authors.initials: YC
authors.lastname: Ahn
authors.forename: Ho Kyung
authors.initials: HK
authors.lastname: Chun
authors.forename: Woo Yong
authors.initials: WY
authors.lastname: Lee
authors.forename: Seong Hyeon
authors.initials: SH
authors.lastname: Yun
authors.forename: Hee Cheol
authors.initials: HC
authors.lastname: Kim
authors.forename: Yong Beom
authors.initials: YB
authors.lastname: Cho
authors.forename: Won Ki
authors.initials: WK
authors.lastname: Kang
authors.forename: Young Suk
authors.initials: YS
authors.lastname: Park
authors.forename: Joon Oh
authors.initials: JO
authors.lastname: Park
authors.forename: Ho-Yeong
authors.initials: HY
authors.lastname: Lim
authors.forename: Se Hoon
authors.initials: SH
authors.lastname: Park
authors.forename: Jeeyun
authors.initials: J
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant / Q000401:mortality*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000401:mortality*; D007723:Korea / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D018714:Radiotherapy, Adjuvant / Q000401:mortality*; D012004:Rectal Neoplasms / Q000401:mortality* / Q000628:therapy*; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome