title: Definitive radical external beam radiotherapy for rectal cancer: evaluation of local effectiveness and risk of late small bowel damage.
abstract: OBJECTIVE
  To present a retrospective analysis of results of definitive radiotherapy for rectal cancer.
  
  
  METHODS
  Forty-one consecutive patients with rectal cancer (32% primary, 61% pelvic recurrence and 7% after R2 resection) who could not be treated with surgery underwent external beam radiotherapy. A median tumour dose of 64 Gy was given with 1.8-2.5 Gy per fraction using 2D or 3D technique. In 46% of patients, concurrent 5-Fu-based chemotherapy was given. The median follow-up was 54 months.
  
  
  RESULTS
  Clinical complete response was achieved in 39% of patients. Five-year cumulative incidence of local failure, overall survival and cancer specific survival were 76%, 26% and 30%, respectively. Of 11 patients with local control, in five cases the tumour was larger than 5 cm and in the other five the tumour was fixed. Two patients, regarded as locally controlled had non-progressive tumour without local symptoms at the last follow-up of 54 and 118 months post-radiotherapy. Late toxicity occurred in 22% of patients, all with acceptable severity. There was no bowel obstruction requiring surgery despite that in 18 patients the small bowel dose was >60 Gy to a mean volume of 51 cm(3).
  
  
  CONCLUSIONS
  Definitive radio(chemo)therapy provides a chance for local control even in patients with large fixed or recurrent rectal cancer.
authors.affiliation: Department of Radiotherapy Maria Sklodowska-Curie Memorial Cancer Centre, Warsaw, Poland. asprawka@amg.gda.pl
authors.forename: Arkadiusz
authors.initials: A
authors.lastname: Sprawka
authors.forename: Lucyna
authors.initials: L
authors.lastname: Pietrzak
authors.forename: Dariusz
authors.initials: D
authors.lastname: Garmol
authors.forename: Dobromira
authors.initials: D
authors.lastname: Tyc-Szczepaniak
authors.forename: Lucyna
authors.initials: L
authors.lastname: Kepka
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Bujko
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000532:radiotherapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007421:Intestine, Small / Q000473:pathology / Q000528:radiation effects*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000209:etiology; D011832:Radiation Injuries / Q000453:epidemiology / Q000209:etiology*; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000379:methods*; D012004:Rectal Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D012074:Remission Induction / Q000379:methods; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome