title: Impact of neoadjuvant chemoradiation on pathologic response and survival of patients with locally advanced rectal cancer.
abstract: BACKGROUND
  The impact of neoadjuvant chemotherapy (CT) and radiotherapy (RT) on overall survival (OS) has been controversial. Some studies have pointed to an improvement in OS and disease-free survival (DFS) in patients with pathologic complete response (pCR).
  
  
  OBJECTIVE
  To evaluate the therapeutic response and impact on survival of preoperative RT, alone or combined with CT, in patients with locally advanced rectal cancer (LARC).
  
  
  METHODS
  A set of 132 patients with LARC were treated preoperatively. GROUP 1: RT alone, 19 patients. GROUP 2: RT and concomitant oral CT (Capecitabine or UFT + leucovorin), 68 patients. GROUP 3: RT and concomitant CT with 5-FU in continuous infusion, 45 patients. 58.2% of patients were submitted to adjuvant CT.
  
  
  RESULTS
  GROUP 1: no pCR, tumoral downstaging was 26.7%. GROUP 2: pCR in 16.9%; tumoral downstaging was 47.7%. GROUP 3: pCR in 11.9%; tumor downstaging was 52.4%. The loco-regional control (LRC) was 95%. The 5-year OS (p = 0.038) and DFS (p = 0.05) were significantly superior in patients treated with CT + RT. Patients with pCR had a significant increase on DFS (p = 0.019). Patients cT3-4 that had a tumoral downstaging to ypT0-2, showed an increase on DFS, OS and LRC.
  
  
  CONCLUSIONS
  CT combined with RT has increased tumoral response and survival rate. Nodal downstaging and pCR were higher in the GROUP 2. The 5-year OS and DFS were significantly superior in CT + RT arms. Patients with pathologic response showed a better DFS. Adjuvant CT had no impact on LRC, DFS nor on OS.
authors.affiliation: Radiotherapy Department, Coimbra University Hospital, Portugal.
authors.forename: Sofia
authors.initials: S
authors.lastname: Conde
authors.affiliation: Radiotherapy Department, Coimbra University Hospital, Portugal.
authors.forename: Margarida
authors.initials: M
authors.lastname: Borrego
authors.affiliation: Radiotherapy Department, Coimbra University Hospital, Portugal.
authors.forename: Tânia
authors.initials: T
authors.lastname: Teixeira
authors.affiliation: Radiotherapy Department, Coimbra University Hospital, Portugal.
authors.forename: Rubina
authors.initials: R
authors.lastname: Teixeira
authors.affiliation: Radiotherapy Department, Coimbra University Hospital, Portugal.
authors.forename: Maria
authors.initials: M
authors.lastname: Corbal
authors.affiliation: Oncology Department, Coimbra University Hospital, Portugal.
authors.forename: Anabela
authors.initials: A
authors.lastname: Sá
authors.affiliation: Radiotherapy Department, Coimbra University Hospital, Portugal.
authors.forename: Paula
authors.initials: P
authors.lastname: Soares
keywords: Adjuvant chemotherapy; Neoadjuvant chemoradiotherapy; Pathologic complete response; Rectal cancer