title: Upfront systemic chemotherapy and preoperative short-course radiotherapy with delayed surgery for locally advanced rectal cancer with distant metastases.
abstract: BACKGROUND
  Choosing the most effective approach for treating rectal cancer with mesorectal fascia (MRF) involvement or closeness and synchronous distant metastases is a current clinical challenge. The aim of this retrospective study was to determine if upfront systemic chemotherapy and short-course radiotherapy (RT) with delayed surgery enables R0 resection.
  
  
  METHODS
  Between March 2009 and October 2009, six patients were selected for upfront chemotherapy and short-course RT (5 × 5 Gy) with delayed surgery. The patients had locally advanced primary tumors with MRF involvement or closeness, as well as synchronous and potentially resectable distant metastases. Chemotherapy was administered to five patients between the end of the RT and surgery. All patients underwent total mesorectal excision (TME).
  
  
  RESULTS
  The median patient age was 54 years (range 39-63). All primary and metastatic lesions were resected simultaneously. The median duration between short-course RT and surgery was 13 weeks (range, 7-18). R0 resection of rectal lesions was achieved in 5 patients. One patient, who had a very low-lying tumor, had an R1 resection. The median follow-up duration for all patients was 16.7 months (range, 15.5-23.5). One patient developed liver metastasis at 15.7 months. There have been no local recurrences or deaths.
  
  
  CONCLUSIONS
  Upfront chemotherapy and short course RT with delayed surgery is a valuable alternative treatment approach for patients with MRF involvement or closeness of rectal cancer with distant metastases.
authors.affiliation: Department of Radiation Oncology, Yonsei Colorectal Cancer Clinic, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Sang Joon
authors.initials: SJ
authors.lastname: Shin
authors.forename: Hong In
authors.initials: HI
authors.lastname: Yoon
authors.forename: Nam Kyu
authors.initials: NK
authors.lastname: Kim
authors.forename: Kang Young
authors.initials: KY
authors.lastname: Lee
authors.forename: Byung Soh
authors.initials: BS
authors.lastname: Min
authors.forename: Joong Bae
authors.initials: JB
authors.lastname: Ahn
authors.forename: Ki Chang
authors.initials: KC
authors.lastname: Keum
authors.forename: Woong Sub
authors.initials: WS
authors.lastname: Koom
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy / Q000379:methods; D005205:Fascia / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008495:Medical Oncology / Q000379:methods; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011878:Radiotherapy / Q000379:methods*; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D012008:Recurrence; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome