title: Oncologic outcomes of neoadjuvant chemoradiation for locally advanced rectal cancer: a single-institution experience.
abstract: BACKGROUND
  This study reports the outcomes of patients with locally advanced rectal cancer treated with neoadjuvant chemoradiation followed by surgery in a local population of Singapore.
  
  
  METHODS
  The records of 85 patients who underwent neoadjuvant chemoradiation for locally advanced rectal cancer followed by surgery at the Tan Tock Seng Hospital (TTSH) between November 2002 and January 2012 were reviewed. The treatment protocol comprised radiotherapy to a total dose of 50.4 Gy concurrent with 5-fluorouracil-based chemotherapy. Patients underwent total mesorectal excision surgery following the completion of neoadjuvant chemoradiation. Local control, disease-free survival and overall survival were analysed using Kaplan-Meier methods.
  
  
  RESULTS
  Median age of the patients was 61 years. All of them completed radiotherapy. One patient did not complete neoadjuvant chemotherapy. The median time to surgery was 52 days. Fifty-five percent (47 of 85) of patients achieved pathological downstaging and 13% (11 of 85) of patients had a pathologic complete response to preoperative treatment. The neoadjuvant chemoradiation was well tolerated. Four percent of patients had grade 3 diarrhoea and 4% of them had grade 3 dermatitis. There were no grade 4 toxicities. With a median follow-up of 41 months, the 5-year actuarial local recurrence, disease-free survival and overall survival rates were 7%, 71.9%, and 83.2% respectively. Univariate analysis showed that patients with positive surgical margins had significantly worse disease-free survival and overall survival (P=0.012 and P<0.001 respectively) and a trend towards a higher rate of local recurrence (P=0.08).
  
  
  CONCLUSIONS
  Our study provides evidence that neoadjuvant chemoradiation is an effective treatment for locally advanced rectal cancer. Our outcomes are comparable with internationally published data and demonstrate the reproducibility of the neoadjuvant approach in an Asian population.
authors.affiliation: Department of Radiation Oncology, National University Hospital, National University Cancer Institute, Singapore.
authors.forename: Yiat Horng
authors.initials: YH
authors.lastname: Leong
authors.forename: Cheng Nang
authors.initials: CN
authors.lastname: Leong
authors.forename: Guan Sze
authors.initials: GS
authors.lastname: Tay
authors.forename: Richard
authors.initials: R
authors.lastname: Sim
authors.forename: Gilberto
authors.initials: G
authors.lastname: Lopes
authors.forename: Wilson
authors.initials: W
authors.lastname: Low
authors.forename: Bok Ai
authors.initials: BA
authors.lastname: Choo
authors.forename: Jeremy
authors.initials: J
authors.lastname: Tey
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059186:Chemoradiotherapy, Adjuvant; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D012004:Rectal Neoplasms / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome