title: Effectiveness of adjuvant radiotherapy after local excision of rectal cancer with deep submucosal invasion: a single-hospital, case-control analysis.
abstract: BACKGROUND
  The role of postoperative radiation therapy (RT) after local excision (LE) of deep submucosal invasive rectal cancer remains unclear. We evaluated the efficacy of adjuvant RT after LE of early rectal cancer with deep submucosal invasion.
  
  
  METHODS
  We screened 227 patients who underwent transanal excision or endoscopic removal of deep submucosal invasive rectal cancer between 1992 and 2012, of which 66 did not undergo radical surgery owing to the patient's preference or poor medical conditions. Of these, 35 (53 %) underwent LE alone (LE group) and 31 (47 %) received adjuvant RT after LE (LE + RT group). Nine patients in the RT group received concurrent adjuvant chemotherapy with 5-fluorouracil. Two independent pathologists reviewed histological data.
  
  
  RESULTS
  The mean age of patients in the LE + RT and LE groups was 59.5 ± 9.6 and 55.3 ± 11.2 years, respectively. The mean follow-up duration was 78.7 ± 66.7 months in the LE + RT group and 70.5 ± 45.7 months in the LE group. Cancer eventually recurred in six patients (9.1 %; two in the LE + RT group and four in the LE group). In five of these patients, recurrence occurred within 4 years after the initial treatment. The other patient, who was in the LE group, exhibited multiple lymph node metastases at the 116-month follow-up. Kaplan-Meier estimates of recurrence-free survival at 5 years after treatment were 96.8 % in the LE + RT group and 97 % in the LE group (P = 0.657).
  
  
  CONCLUSIONS
  RT after LE of early rectal cancer with deep submucosal invasion might not improve recurrence-free survival compared with LE alone.
authors: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea. seohyunism@naver.com.
authors: Seohyun
authors: S
authors: Lee
authors: Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors: Chang Gok
authors: CG
authors: Woo
authors: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
authors: Hyo Jeong
authors: HJ
authors: Lee
authors: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
authors: Kyung-Jo
authors: KJ
authors: Kim
authors: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
authors: Byong Duk
authors: BD
authors: Ye
authors: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
authors: Jeong-Sik
authors: JS
authors: Byeon
authors: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
authors: Seung-Jae
authors: SJ
authors: Myung
authors: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
authors: Suk-Kyun
authors: SK
authors: Yang
authors: Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors: Young Soo
authors: YS
authors: Park
authors: Department of Radiation Oncology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors: Jin-Hong
authors: JH
authors: Park
authors: Department of Radiation Oncology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors: Jong Hoon
authors: JH
authors: Kim
authors: Department of Colon and Rectal Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
authors: Seok-Byung
authors: SB
authors: Lim
authors: Department of Colon and Rectal Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
authors: Jin Cheon
authors: JC
authors: Kim
authors: Department of Colon and Rectal Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea. csyu007@gmail.com.
authors: Chang Sik
authors: CS
authors: Yu
authors: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea. dhyang@amc.seoul.kr.
authors: Dong-Hoon
authors: DH
authors: Yang
mesh_terms: D000328:Adult; D003082:Colectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D012189:Retrospective Studies
keywords: Deep submucosal invasion; Local excision; Rectal cancer