title: Adjuvant chemoradiation plus intraoperative radiotherapy versus adjuvant chemoradiation alone in patients with locally advanced rectal cancer.
abstract: OBJECTIVE
  To document the efficacy of intraoperative radiotherapy (IORT) followed by adjuvant chemoradiation in the management of locally advanced rectal cancer.
  
  
  METHODS
  A total of 148 patients with pT4N0/T1-4N+ rectal adenocarcinoma were enrolled. Seventy-seven patients received total mesorectal excision surgery followed by adjuvant chemoradiation alone, 71 patients received total mesorectal excision surgery followed by IORT (range, 10 to 20 Gy) and adjuvant chemoradiation.
  
  
  RESULTS
  The 5-year local control (LC) and disease-free survival were 79.2% versus 89.7% (P=0.032), 58.5% versus 69.0% (P=0.049) for external-beam radiation (EBRT) and IORT+EBRT groups, respectively. Multivariate analysis revealed that adjuvant IORT has a trend toward improvement of LC (P=0.079); 5 (3%) patients (EBRT n=2; IORT n=3) experienced incomplete intestinal obstruction and 3 patients had chronic diarrhea. There was no clinically relevant neuropathy or sacral osteoradionecrosis. Hydronephrosis occurred in 13 patients (EBRT n=8; IORT+EBRT n=5), 8 of whom had documented concomitant disease recurrence.
  
  
  CONCLUSIONS
  For patients with locally advanced rectal cancer, higher radiation dose may contribute to the improvement of both LC and disease-free survival, without significantly increasing the incidence of acute and long-term complications compared with adjuvant chemoradiotherapy alone.
authors.affiliation: Departments of *Radiation Oncology ‡Surgery, The Sixth Hospital of Jiao Tong University, Shanghai, People's Republic of China †Department of Radiation Oncology, Cancer Institute, National University Hospital, National Healthcare Group of Singapore, Singapore.
authors.forename: Qing
authors.initials: Q
authors.lastname: Zhang
authors.forename: Jeremy
authors.initials: J
authors.lastname: Tey
authors.forename: Zhe
authors.initials: Z
authors.lastname: Yang
authors.forename: Ping
authors.initials: P
authors.lastname: Li
authors.forename: Lihua
authors.initials: L
authors.lastname: Peng
authors.forename: Shen
authors.initials: S
authors.lastname: Fu
authors.forename: Guofeng
authors.initials: G
authors.lastname: Huang
authors.forename: Fei
authors.initials: F
authors.lastname: Xiong
authors.forename: Jiade J
authors.initials: JJ
authors.lastname: Lu
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D059186:Chemoradiotherapy, Adjuvant / Q000379:methods; D002945:Cisplatin / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D002955:Leucovorin / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant / Q000379:methods; D012004:Rectal Neoplasms / Q000473:pathology / Q000628:therapy*; D012007:Rectum / Q000601:surgery*
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D002945:Cisplatin; D002955:Leucovorin; D005472:Fluorouracil