title: Aspirin as a neoadjuvant agent during preoperative chemoradiation for rectal cancer.
abstract: BACKGROUND
  Recently, many studies have suggested a possible adjuvant role of aspirin in colorectal cancer, reporting a positive prognostic effect with its use in patients with established disease. The aim of this study was to investigate the anticancer effect of aspirin use during preoperative chemoradiation for rectal cancer.
  
  
  METHODS
  Two hundred and forty-one patients with stage II-III rectal cancer and candidates for chemoradiation (CRT) were selected and assigned to two groups: group 1, patients taking aspirin at the time of diagnosis, and group 2, all others. Treatment and oncological outcomes were explored.
  
  
  RESULTS
  Aspirin use was associated with a higher rate of tumour downstaging (67.6% vs 43.6%, P=0.01), good pathological response (46% vs 19%; P<0.001), and a slightly, although not significant, higher rate of complete pathological response (22% vs 13%; P=0.196). Aspirin use was also associated with a better 5-year progression-free survival (86.6% vs 67.1%; hazard rate (HR)=0.20; 95% CI=0.07-0.60) and overall survival (90.6% vs 73.2%; HR=0.21; 95% CI=0.05-0.89). Although chance of local relapse was similar (HR=0.6; 95% CI=0.06-4.5), aspirin use was associated with a lower risk of developing metastasis (HR=0.30; 95% CI=0.10-0.86).
  
  
  CONCLUSIONS
  Aspirin might have anticancer activity against rectal cancer during preoperative CRT. This finding could be clinically relevant and should be further investigated with randomised trials.
authors.affiliation: Department of Surgery, Colorectal Surgery Center, University of Cagliari, Azienda Ospedaliera Universitaria, Policlinico Universitario, Monserrato 09042, Cagliari, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Restivo
authors.affiliation: Department of Surgery, Colorectal Surgery Center, University of Cagliari, Azienda Ospedaliera Universitaria, Policlinico Universitario, Monserrato 09042, Cagliari, Italy.
authors.forename: Ivana Maria Francesca
authors.initials: IM
authors.lastname: Cocco
authors.affiliation: Department of Surgery, Colorectal Surgery Center, University of Cagliari, Azienda Ospedaliera Universitaria, Policlinico Universitario, Monserrato 09042, Cagliari, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Casula
authors.affiliation: Department of Surgery, Colorectal Surgery Center, University of Cagliari, Azienda Ospedaliera Universitaria, Policlinico Universitario, Monserrato 09042, Cagliari, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Scintu
authors.affiliation: Department of Surgery, Colorectal Surgery Center, University of Cagliari, Azienda Ospedaliera Universitaria, Policlinico Universitario, Monserrato 09042, Cagliari, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cabras
authors.affiliation: Department of Medical Sciences, Medical Oncology, University of Cagliari, Azienda Ospedaliera Universitaria, Policlinico Universitario, Monserrato 09042, Cagliari, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Scartozzi
authors.affiliation: Department of Surgery, Colorectal Surgery Center, University of Cagliari, Azienda Ospedaliera Universitaria, Policlinico Universitario, Monserrato 09042, Cagliari, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Zorcolo
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001241:Aspirin; D059248:Chemoradiotherapy / Q000379:methods; D017024:Chemotherapy, Adjuvant / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*
chemical_list: D000970:Antineoplastic Agents; D001241:Aspirin