title: Sphincter preservation in distal CT2N0 rectal cancer after preoperative chemoradiotherapy.
abstract: BACKGROUND
  Preoperative chemoradiotherapy is usually not indicated for cT2N0 rectal cancer. Abdominoperineal resection is the standard treatment for distal rectal tumors. The aim of the study was to evaluate the actual sphincter-preservation rate in patients with distal cT2N0 rectal cancer given neoadjuvant chemoradiotherapy.
  
  
  METHODS
  Data were retrospectively collected for all patients who were diagnosed with distal cT2N0 rectal cancer at a tertiary medical center in 2000-2008 and received chemoradiotherapy followed by surgery (5-7 weeks later).
  
  
  RESULTS
  Thirty-three patients (22 male) of median age 65 years (range, 32-88) were identified. Tumor distance from the anal verge ranged from 0 to 5 cm. R0 resection with sphincter preservation was accomplished in 22 patients (66%), with a 22% pathological complete response rate. Median follow-up time was 62 months (range 7-120). There were no local failures. Crude disease-free and overall survival were 82% and 86%, respectively. Factors associated with sphincter preservation were tumor location (OR=0.58, p=0.02, 95% CI=0.37-0.91) and pathological downstaging (OR=7.8, p=0.02, 95% CI=1.35-45.85). Chemoradiotherapy was well tolerated.
  
  
  CONCLUSIONS
  High rates of sphincter preservation can be achieved after preoperative chemoradiotherapy for distal cT2N0 rectal cancer, with tolerable toxicity, without compromising oncological outcome.
authors.affiliation: Department of Surgery B, Petach Tikva, 49100, Israel. nirw@clalit.org.il.
authors.forename: Nir
authors.initials: N
authors.lastname: Wasserberg
authors.affiliation: Davidoff Cancer Center, Rabin Medical Center, Beilinson Campus, Petach Tikva, 49100, Israel. yuliak@clalit.org.il.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel. yuliak@clalit.org.il.
authors.forename: Yulia
authors.initials: Y
authors.lastname: Kundel
authors.affiliation: Davidoff Cancer Center, Rabin Medical Center, Beilinson Campus, Petach Tikva, 49100, Israel. oferp@clalit.org.il.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel. oferp@clalit.org.il.
authors.forename: Ofer
authors.initials: O
authors.lastname: Purim
authors.affiliation: Department of Surgery B, Petach Tikva, 49100, Israel. keidar66@yahoo.com.
authors.forename: Andrei
authors.initials: A
authors.lastname: Keidar
authors.affiliation: Department of Surgery B, Petach Tikva, 49100, Israel. hkashtan@clalit.org.il.
authors.forename: Hanoch
authors.initials: H
authors.lastname: Kashtan
authors.affiliation: Department of Surgery B, Petach Tikva, 49100, Israel. sadote@mskcc.org.
authors.forename: Eran
authors.initials: E
authors.lastname: Sadot
authors.affiliation: Davidoff Cancer Center, Rabin Medical Center, Beilinson Campus, Petach Tikva, 49100, Israel. efenig@clalit.org.il.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel. efenig@clalit.org.il.
authors.forename: Eyal
authors.initials: E
authors.lastname: Fenig
authors.affiliation: Davidoff Cancer Center, Rabin Medical Center, Beilinson Campus, Petach Tikva, 49100, Israel. brennerb@clalit.org.il.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel. brennerb@clalit.org.il.
authors.forename: Baruch
authors.initials: B
authors.lastname: Brenner
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000502:physiology / Q000601:surgery*; D059248:Chemoradiotherapy; D013505:Digestive System Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D059351:Organ Sparing Treatments; D011300:Preoperative Care; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies