title: A prospective analysis of patient outcome following treatment of T3 rectal cancer with neo-adjuvant chemoradiotherapy and transanal excision.
abstract: BACKGROUND
  Local excision is an alternative to anterior or abdomino-perineal resection in patients with early rectal cancer. In more advanced disease, neo-adjuvant therapy (CRXT) can result in significant disease regression such that local excision may be considered. The primary aim was to assess oncological outcome in patients with T3 rectal cancer treated with CRXT and local excision due to unsuitability for or aversion to anterior resection and stoma. The secondary aim was to examine oncological outcomes in patients treated in a similar way in the published literature.
  
  
  METHODS
  Between July 2006 and July 2009, patients with rectal cancer staged T3, N0/N1, M0 who were deemed unfit for or who refused anterior resection were offered long-course CRXT. Patients were restaged 8 weeks following completion. If there was a good response (regression grade 2 or 3 clinically and radiologically), full thickness transanal excision was performed. All patients were followed regularly (monthly CT abdomen/pelvis and annual endoscopy) to assess for recurrence of disease. A literature search of PubMed was performed to identify all prospective data available of T3 rectal cancers managed with CRXT and local excision.
  
  
  RESULTS
  Ten patients were treated over 3 years. Six patients had complete pathological response, while four patients had a partial response. The resection margins following local excision were clear in all. There was no local recurrence (median follow-up 24 months, range 9-42 months).
  
  
  CONCLUSIONS
  Neo-adjuvant chemoradiotherapy and local excision is an option in patients unfit for or averse to major surgical resection if there is a good response to CRXT.
authors.affiliation: Department of Surgery, St. Vincent's University Hospital and School of Medicine and Medical Sciences, University College Dublin, Dublin 4, Ireland. kennellyrory@yahoo.ie
authors.forename: Rory P
authors.initials: RP
authors.lastname: Kennelly
authors.forename: Anna
authors.initials: A
authors.lastname: Heeney
authors.forename: Anne
authors.initials: A
authors.lastname: White
authors.forename: David
authors.initials: D
authors.lastname: Fennelly
authors.forename: Kieran
authors.initials: K
authors.lastname: Sheahan
authors.forename: John M P
authors.initials: JM
authors.lastname: Hyland
authors.forename: P Ronan
authors.initials: PR
authors.lastname: O'Connell
authors.forename: Desmond C
authors.initials: DC
authors.lastname: Winter
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery*; D059186:Chemoradiotherapy, Adjuvant; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D016896:Treatment Outcome