title: Feasibility of modified short-course radiotherapy combined with a chemoradiosensitizer for T3 rectal cancer.
abstract: BACKGROUND
  5-Fluorouracil-based chemotherapy is considered to be a radiosensitizer; however, conventional short-course radiotherapy combined with chemotherapy is generally thought to not be feasible because of the prevalence of side effects.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the feasibility of modified short-course radiotherapy combined with a chemoradiosensitizer for T3 rectal cancer.
  
  
  METHODS
  This study was retrospective in nature and used a prospectively collected database.
  
  
  METHODS
  Patients with T3 rectal cancer located below the peritoneum reflection were selected.
  
  
  METHODS
  A total dose of 25 Gy of radiotherapy was administered in 10 fractions of 2.5 Gy each for 5 days. Radiotherapy was performed with S-1 as a radiosensitizer from day 1 to day 10. Surgery was targeted to be performed 4 weeks after radiotherapy.
  
  
  METHODS
  The morbidity, sphincter-preserving rate, anal function, and long-term outcomes were assessed.
  
  
  RESULTS
  All patients (n = 170) completed the radiotherapy regimen and 166 (97.6%) completed the combination regimen with chemotherapy. A total of 149 patients (87.6%) had sphincter-preserving surgery (double stapling technique (DST), 58 patients; intersphincteric resection (ISR), 91 patients), and postoperative complications were relatively mild (anastomotic leakage, 15.4%; intra-abdominal infection, 8.2%). Among those undergoing sphincter preserving surgery, the 5-year local relapse-free survival rate was 94.3% in the DST group, and 89.8% in the ISR group. With respect to the anal function, the Wexner score the first year after stoma closure for the double-stapling technique group was 6 and that for intersphincteric resection was 15; however, the score for the intersphincteric resection group was improved to 8 at 4 years after stoma closure.
  
  
  CONCLUSIONS
  This study had limitations because it was an uncontrolled, 1-arm, retrospective review with a small sample size.
  
  
  CONCLUSIONS
  Modified short-course radiotherapy combined with chemoradiosensitizer is a feasible approach for treating T3 rectal cancer. With the use of the short-course approach, efforts to reduce the incidence of side effects by appropriately prolonging the waiting period enable the administration of combination treatment with short-course radiotherapy and chemotherapy.
authors: 1 Department of Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan 2 Department of Pathology, Meiwa Hospital, Nishinomiya, Hyogo, Japan 3 Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan 4 Department of Surgery, Meiwa Hospital, Nishinomiya, Hyogo, Japan.
authors: Naohito
authors: N
authors: Beppu
authors: Nagahide
authors: N
authors: Matsubara
authors: Ayako
authors: A
authors: Kakuno
authors: Hiroshi
authors: H
authors: Doi
authors: Norihiko
authors: N
authors: Kamikonya
authors: Naoki
authors: N
authors: Yamanaka
authors: Hidenori
authors: H
authors: Yanagi
authors: Naohiro
authors: N
authors: Tomita
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000532:radiotherapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D059248:Chemoradiotherapy; D016208:Databases, Factual; D019583:Dose Fractionation, Radiation; D004338:Drug Combinations; D005240:Feasibility Studies; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009367:Neoplasm Staging; D059351:Organ Sparing Treatments; D010094:Oxonic Acid / Q000627:therapeutic use*; D011183:Postoperative Complications; D011838:Radiation-Sensitizing Agents / Q000627:therapeutic use*; D012004:Rectal Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D005641:Tegafur / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000964:Antimetabolites, Antineoplastic; D004338:Drug Combinations; D011838:Radiation-Sensitizing Agents; C079198:S 1 (combination); D005641:Tegafur; D010094:Oxonic Acid