title: The location of locoregional recurrence in pathologic T3N0, non-irradiated lower rectal cancer.
abstract: OBJECTIVE
  To investigate the patterns of locoregional recurrence of pathologic T3N0 (pT3N0) lower rectal cancer omitting postoperative radiotherapy (RT) and explore the potential of modification of a RT field.
  
  
  METHODS
  From Jan 2003 to Nov 2011, 35 patients omitting preoperative or postoperative RT for pT3N0 lower rectal cancer were included. We defined the lower rectal cancer as the tumor with the inferior margin located below the virtual line-a convergent level between rectal wall and levator ani muscle. All patients had radiologic examinations for recurrence evaluation during the follow-up duration.
  
  
  RESULTS
  The median follow-up duration was 66.4 months (range, 1.4 to 126.1 months). Eight (22.9%) of the 35 patients had recurrence. Three (8.6%) was local recurrence (LR) only, 3 (8.6%) was distant metastasis (DM) only, and 2 (5.7%) was LR with DM. All LR were located at primary tumor sites. The overall survival rate, LR-free survival rate, and DM-free survival rate at 5 years was 79.8%, 83%, and 87%, respectively. All LR developed from tumors over 5 cm. However, there was no statistical significance (p = 0.065). There was no other risk factor for LR.
  
  
  CONCLUSIONS
  Even though the patients included in this study had pathologically favorable pT3N0 rectal cancer, LR developed in 14.3% of patients. Most of the LR was located at primary tumor sites prior to surgery. Based on these findings, it might seem reasonable to consider postoperative RT with a smaller radiation field to the primary tumor site rather than the conventional whole pelvic irradiation.
authors.affiliation: Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Mi Sun
authors.initials: MS
authors.lastname: Kim
authors.forename: Ki Chang
authors.initials: KC
authors.lastname: Keum
authors.forename: Woo Joong
authors.initials: WJ
authors.lastname: Rhee
authors.forename: Hyunju
authors.initials: H
authors.lastname: Kim
authors.forename: Minji
authors.initials: M
authors.lastname: Kim
authors.forename: Seohee
authors.initials: S
authors.lastname: Choi
authors.forename: Ki Chang
authors.initials: KC
authors.lastname: Nam
authors.forename: Woong Sub
authors.initials: WS
authors.lastname: Koom
keywords: Adjuvant radiotherapy; Locoregional neoplasm recurrence; Rectal cancer