title: Preoperative radiotherapy and local excision of rectal cancer with immediate radical re-operation for poor responders: a prospective multicentre study.
abstract: OBJECTIVE
  To assess local control after preoperative radiation and local excision and to determine an optimal radiotherapy regimen.
  
  
  METHODS
  Eighty-nine patients with G1-2 rectal adenocarcinoma <3-4 cm; unfavourable cT1N0 (23.6%), cT2N0 (62.9%) or borderline cT2/cT3N0 (13.5%) received 5 × 5 Gy plus 4 Gy boost (71.9%) or 55.8 Gy in 31 fractions with 5-FU and leucovorin (28.1%). Local excision (traditional technique 56.2%, transanal endoscopic microsurgery 41.6%, Kraske procedure 2.2%) was performed 6-8 weeks later. If patients were downstaged to ypT0-1 without unfavourable factors (good responders), this was deemed definitive treatment. Immediate conversion to radical surgery was recommended for remaining patients.
  
  
  RESULTS
  Good response to radiation was seen in 67.2% of patients in the short-course group and in 80.0% in the chemoradiation group, p = 0.30. Local recurrence at 2 years (median follow-up) in good responders was 11.8% in the short-course group and 6.2% in the chemoradiation group, p = 0.53. In the total group, a lower rate of local recurrence at 2 years was observed in elderly patients (>69 years, median value) when compared to the younger patients; 8.3% vs. 27.7%, Cox analysis hazard ratio 0.232, p = 0.016. A total of 18 patients initially managed with local excision required conversion to abdominal surgery but either refused it or were unfit. In this group, local recurrence at 2 years was 37.1%.
  
  
  CONCLUSIONS
  This study suggests an acceptable local recurrence rate after preoperative radiotherapy and local excision of small, radiosensitive tumours in elderly patients.
authors: Department of Radiotherapy, Maria Sklodowska-Curie Memorial Cancer Centre, Warsaw, Poland. bujko@coi.waw.pl
authors: Krzysztof
authors: K
authors: Bujko
authors: Piotr
authors: P
authors: Richter
authors: Fraser M
authors: FM
authors: Smith
authors: Wojciech
authors: W
authors: Polkowski
authors: Marek
authors: M
authors: Szczepkowski
authors: Andrzej
authors: A
authors: Rutkowski
authors: Adam
authors: A
authors: Dziki
authors: Lucyna
authors: L
authors: Pietrzak
authors: Milena
authors: M
authors: Kołodziejczyk
authors: Jerzy
authors: J
authors: Kuśnierz
authors: Tomasz
authors: T
authors: Gach
authors: Jan
authors: J
authors: Kulig
authors: Grzegorz
authors: G
authors: Nawrocki
authors: Jakub
authors: J
authors: Radziszewski
authors: Ryszard
authors: R
authors: Wierzbicki
authors: Teresa
authors: T
authors: Kowalska
authors: Wiktor
authors: W
authors: Meissner
authors: Andrzej
authors: A
authors: Radkowski
authors: Krzysztof
authors: K
authors: Paprota
authors: Marcin
authors: M
authors: Polkowski
authors: Anna
authors: A
authors: Rychter
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D012086:Reoperation