title: Long-term oncologic results in cancer of the rectum treated by preoperative chemoradiotherapy and surgery: An analysis of 500 cases.
abstract: BACKGROUND
  The standard treatment for locally advanced cancer of the rectum (LACR) and selective cases of stage IV disease is preoperative chemoradiotherapy (CRT) followed by total mesorectal excision (TME). Despite reductions in local recurrence, disease-free survival (DSF) has remained stable in recent years.
  
  
  OBJECTIVE
  The objective of this study is to analyze patterns of recurrence, long-term survival and prognostic factors in a program of neoadjuvant CRT and surgery in LACR.
  
  
  METHODS
  Between January 1992 and December 2011, 446 patients with LACR and 54 patients (with single metastases) were treated with pre-operative long course CRT and surgery. Three hundred forty four (66.8%) anterior resections of the rectum and 123 (24.6%) abdomino-perineal resections were performed.
  
  
  RESULTS
  With a mean follow-up of 70.06 months, local recurrence was 4.8% and distant recurrence 25.5%. No differences were found in the histopathologic prognostic factors across the three groups studied depending on distance (cm) from the analmargin. Involvement of the circumferential resection margin (CRM+) was significantly greater in tumors in the distal third of the rectum (8.5%; p = 0.04). 67 patients (13.4%) showed a complete pathologic response. DSF at 5 and 10 years was significantly lower in patients with tumors affecting the distal third as compared to the middle third of the rectum (61.9% vs. 57.7%; p = 0.04). Tumors at this distal location resulted in a significantly higher incidence of lung metastases (p = 0.016).
authors.forename: Javier A
authors.initials: JA
authors.lastname: Cienfuegos
authors.forename: Jorge
authors.initials: J
authors.lastname: Baixauli
authors.forename: Carlos
authors.initials: C
authors.lastname: Pastor
authors.forename: Jorge
authors.initials: J
authors.lastname: Arredondo
authors.forename: Jesús Javier
authors.initials: JJ
authors.lastname: Sola
authors.forename: Leire
authors.initials: L
authors.lastname: Arbea
authors.forename: Ana
authors.initials: A
authors.lastname: Chopitea
authors.forename: José Luis
authors.initials: JL
authors.lastname: Hernández-Lizoáin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059186:Chemoradiotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000517:prevention & control; D009367:Neoplasm Staging; D011379:Prognosis; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D012007:Rectum / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome