title: [Preoperative chemoradiotherapy for rectal cancer: experience from one centre].
abstract: OBJECTIVE
  In recent decades, the management of rectal cancer has been significantly improved by optimizing the surgical treatment with the total mesorectal excision and the development of neoadjuvant radiotherapy with or without chemotherapy. In this study, we investigated the impact of changes in practice over a period of 15 years in an expert centre.
  
  
  METHODS
  A monocentric study was conducted retrospectively on cT3-resectable T4 patients who received chemoradiotherapy for a locally advanced rectal adenocarcinoma between 1993 and 2008. We studied sphincter preservation, pathological complete response (ypT0), survival, and toxicities by different concomitant chemotherapy and treatment period.
  
  
  RESULTS
  Among the 179 patients who had a chemoradiotherapy, 56.4% were received concomitant 5-fluoro-uracil-leucovorin, 28.5% with concomitant capecitabine, and 15.1% with concomitant oxaliplatin and capecitabine. The average dose of radiotherapy was 45 Gy (25×1.8 Gy). Five-year disease-free survival was 74.3% and overall survival 68.8%. The rate of local recurrence and distant metastases were 6.1 and 23.6%. In multivariate analysis, concomitant chemotherapy oxaliplatin and capecitabine improved the pathological complete response rate (ypT0; capecitabine: 6%, 5-fluoro-uracil-leucovorin: 10.3%, capecitabine-oxaliplatin: 22.2%), but not significantly (P=0.12) and with more toxicities, and treatment interruptions. Sphincter preservation rate was not improved significantly during the study period (1993-2004 vs. 2005-2008), but disease-free survival improved from 72.2% up to 87.5% (P=0.03).
  
  
  CONCLUSIONS
  Our results are consistent with those published in the literature. Concomitant chemotherapy with 5-fluoro-uracil or capecitabine remains the standard scheme. Upfront chemotherapy, before chemoradiotherapy, should be investigated with regard to the predominance of metastasis.
authors.affiliation: Service d'oncologie-radiothérapie, CHU Jean-Minjoz, 3, boulevard Fleming, 25030 Besançon cedex, France. Electronic address: lescut.nicolas@hotmail.fr.
authors.forename: N
authors.initials: N
authors.lastname: Lescut
authors.affiliation: Service d'oncologie-radiothérapie, CHU Jean-Minjoz, 3, boulevard Fleming, 25030 Besançon cedex, France.
authors.forename: A
authors.initials: A
authors.lastname: Lepinoy
authors.affiliation: Service d'oncologie-radiothérapie, centre d'oncologie et de radiothérapie du Parc-Chalon-sur-Saône, 4, allée Saint-Jean-des-Vignes, 71100 Chalon-sur-Saône, France.
authors.forename: B
authors.initials: B
authors.lastname: Schipman
authors.affiliation: Service d'oncologie-radiothérapie, CHU Jean-Minjoz, 3, boulevard Fleming, 25030 Besançon cedex, France.
authors.forename: T
authors.initials: T
authors.lastname: Cerda
authors.affiliation: Service d'oncologie-radiothérapie, CHU Jean-Minjoz, 3, boulevard Fleming, 25030 Besançon cedex, France.
authors.forename: V
authors.initials: V
authors.lastname: Guimas
authors.affiliation: Service d'oncologie-radiothérapie, CHU Jean-Minjoz, 3, boulevard Fleming, 25030 Besançon cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Bednarek
authors.affiliation: Service d'oncologie-radiothérapie, CHU Jean-Minjoz, 3, boulevard Fleming, 25030 Besançon cedex, France.
authors.forename: J-F
authors.initials: JF
authors.lastname: Bosset
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary / Q000601:surgery / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000293:injuries / Q000503:physiopathology; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D000069287:Capecitabine; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects; D003841:Deoxycytidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D002955:Leucovorin / Q000008:administration & dosage / Q000009:adverse effects; D008113:Liver Neoplasms / Q000556:secondary; D008175:Lung Neoplasms / Q000556:secondary; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D016609:Neoplasms, Second Primary / Q000401:mortality; D009944:Organoplatinum Compounds / Q000008:administration & dosage / Q000009:adverse effects; D000077150:Oxaliplatin; D012004:Rectal Neoplasms / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D003841:Deoxycytidine; D000069287:Capecitabine; D002955:Leucovorin; D005472:Fluorouracil
keywords: Adenocarcinoma of the rectum; Adénocarcinome du rectum; Chimioradiothérapie; Neoadjuvant chemoradiation