title: Two-week Course of Preoperative Radiotherapy for Locally Advanced Rectal Adenocarcinoma: 8 Years' Experience in a Single Institute.
abstract: OBJECTIVE
  To evaluate local control and survival in locally advanced rectal adenocarcinoma patients who underwent a preoperative 2-week course of radiotherapy (RT) and to identify prognostic factors influencing the survival rate.
  
  
  METHODS
  We analyzed 377 consecutively treated patients with locally advanced (T3/T4 or node positive) rectal adenocarcinoma. All patients underwent a preoperative 2-week course of RT (30 Gy in 10 fractions) followed by curative surgery. Regression model was used to examine prognostic factors for the disease-free survival (DFS) and overall survival (OS) rates. The Statistical Analysis System software package, version 9.3, was used for analysis.
  
  
  RESULTS
  The median follow-up for all living patients was 63.8 months (range, 5.1 to 131.7). The 5-year DFS and OS rates were 64.5% (95% CI, 59.0-69.4) and 75.6% (95% CI, 70.5-80.0), respectively. The 5-year cumulative incidences of local recurrence and distant metastases were 5.4% (95% CI, 2.9-7.9) and 29.0% (95% CI, 23.9-30.1), respectively. The pathologic complete response rate was achieved in 17 patients (4.5%). The Multivariate Cox Regression model showed that factors affecting DFS were the surgical technique, pre-RT pathologic grade, ypT, ypN, and comorbidity; and factors improving OS were low anterior resection, low pre-RT grade, low ypT, and low ypN.
  
  
  CONCLUSIONS
  Patients treated with preoperative RT with 30 Gy in 10 fractions had similar local control, 5-year DFS and OS to reported long course RT regimen. The surgical technique, pre-RT pathologic grade, ypT, and ypN seemed to affect the OS. Further study on combining a 2-week course of preoperative RT with concurrent chemotherapy would be warranted.
authors.affiliation: Departments of *Radiation Oncology ‡Colorectal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University School of Oncology, Peking University Cancer Hospital, Beijing Cancer Hospital and Institute, Beijing †Department of Radiation Oncology, Teaching Hospital of Fujian Medical University, Fujian Provincial Cancer Hospital, Fuzhou, China §Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE.
authors.forename: Xiang-Gao
authors.initials: XG
authors.lastname: Zhu
authors.forename: Jin-Luan
authors.initials: JL
authors.lastname: Li
authors.forename: Xiao-Fan
authors.initials: XF
authors.lastname: Li
authors.forename: Yong-Heng
authors.initials: YH
authors.lastname: Li
authors.forename: Qian-Yu
authors.initials: QY
authors.lastname: Ni
authors.forename: Lin
authors.initials: L
authors.lastname: Wang
authors.forename: Shan-Wen
authors.initials: SW
authors.lastname: Zhang
authors.forename: Jin
authors.initials: J
authors.lastname: Gu
authors.forename: Yong
authors.initials: Y
authors.lastname: Cai
authors.forename: Chi
authors.initials: C
authors.lastname: Lin
mesh_terms: D000230:Adenocarcinoma / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D013505:Digestive System Surgical Procedures / Q000379:methods; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult