title: Tumor response and negative distal resection margins of rectal cancer after hyperthermochemoradiation therapy.
abstract: BACKGROUND
  The safety of regional hyperthermia has been tested in locally advanced rectal cancer. The aim of this study was to assess the effects of shorter distal margins on local control and survival in rectal cancer patients who were treated with preoperative hyperthermochemoradiation therapy (HCRT) and underwent rectal resection by using the total mesorectal excision (TME) method.
  
  
  METHODS
  Ninety-three patients with rectal adenocarcinoma who received neoadjuvant HCRT (total radiation: 50 Gy) were included in this study. Surgery was performed 8 weeks after HCRT, and each resected specimen was evaluated histologically. Length of distal surgical margins, status of circumferential margins, pathological response, and tumor node metastasis stage were examined for their effects on recurrence and survival.
  
  
  RESULTS
  Fifty-eight (62.4%) patients had tumor regression, and 20 (21.5%) had a pathological complete response. Distal margin length ranged from 1 to 55 mm (median, 21 mm) and did not correlate with local recurrence (p=0.57) or survival (p=0.75) by univariate analysis. Kaplan-Meier estimates of recurrence-free survival and local recurrence for the <10 mm versus ≥10 mm groups were not significantly different. Positive circumferential margins and failure of tumors to respond were unfavorable factors in survival.
  
  
  CONCLUSIONS
  Distal resection margins that are shorter than 10 mm but are not positive appear to be equivalent to longer margins in patients who undergo HCRT followed by rectal resection with TME. To improve the down-staging rate, additional studies are needed.
authors: Department of General Surgical Science, Gunma University, Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan. chuchumi@showa.gunma-u.ac.jp
authors: Soichi
authors: S
authors: Tsutsumi
authors: Yuichi
authors: Y
authors: Tabe
authors: Takaaki
authors: T
authors: Fujii
authors: Satoru
authors: S
authors: Yamaguchi
authors: Toshinaga
authors: T
authors: Suto
authors: Reina
authors: R
authors: Yajima
authors: Hiroki
authors: H
authors: Morita
authors: Toshihide
authors: T
authors: Kato
authors: Mariko
authors: M
authors: Shioya
authors: Jun-Ichi
authors: J
authors: Saito
authors: Takayuki
authors: T
authors: Asao
authors: Takashi
authors: T
authors: Nakano
authors: Hiroyuki
authors: H
authors: Kuwano
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D013505:Digestive System Surgical Procedures; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D005720:Gamma Rays; D006801:Humans; D006979:Hyperthermia, Induced; D002955:Leucovorin / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D009367:Neoplasm Staging; D012004:Rectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D002955:Leucovorin; D005472:Fluorouracil