title: Adjuvant versus neoadjuvant chemoradiotherapy in distal rectal cancer: Comparison of two decades in a single center.
abstract: OBJECTIVE
  Standard surgery alone was not able to decrease local recurrence (LR) rate below 20% in rectal cancer treatment. Thus, many centers administered neoadjuvant radiotherapy (preopRTx) with or without concomitant chemotherapy for the prevention of LR. In this study, the results of 164 consecutive patients with mid- and distal rectal cancer who received surgery and adjuvant chemoradiotherapy (Group A) or neoadjuvant chemoradiotherapy (Group NA) followed by surgery are presented.
  
  
  METHODS
  The staging system used in this study is that of the American Joint Committee on Cancer (AJCC), also known as the TNM system. Eligible patients were required to have radiologically assessed stage 1 (only T2N0M0) to stage 3C (T4bN1-2M0) tumor with pathologically confirmed R0 resection. The surgical method was total mesorectal excision (TME). Radiotherapy was applied with daily 180 cGy fractions for 28 consecutive days. Chemo-therapy comprised 5-fluorouracil (450 mg/m(2)/d) and leucovorin (20 mg/m(2)/d) bolus at days 1-5 and 29-33.
  
  
  RESULTS
  Nine patients (13%) in Group NA achieved pathologic complete response (pCR). In Group NA and Group A, locoregional recurrence (LRR) rates were 6.7% and 30.8%, (p<0.001), the mean LR-free survival was 190.0±7.3 months and 148.0±11.7 months (p=0.002) and the mean overall survival (OS) was 119.2±15.3 months and 103.0±9.4 months (p=0.23), respectively. A significant difference with regard to LR has been obtained with a statistical power of 0.92. Secondary outcome measures (DFS and OS) have not been met.
  
  
  CONCLUSIONS
  Neoadjuvant chemoradiotherapy with TME is an efficient treatment protocol, particularly for the treatment of magnetic resonance imaging-staged 2A to 3C patients with two or three distal rectal adenocarcinomas. Given that a considerable proportion of patients with cT2N0M0 would develop pCR, this method of treatment can be considered for further studies.
authors.affiliation: Clinic of General Surgery, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey.
authors.forename: Baha
authors.initials: B
authors.lastname: Zengel
authors.affiliation: Clinic of General Surgery, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey.
authors.forename: Adam
authors.initials: A
authors.lastname: Uslu
authors.affiliation: Clinic of Radiology, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey.
authors.forename: Zehra
authors.initials: Z
authors.lastname: Adıbelli
authors.affiliation: Clinic of General Surgery, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey.
authors.forename: Halit
authors.initials: H
authors.lastname: Yetiş
authors.affiliation: Clinic of General Surgery, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey.
authors.forename: Fevzi
authors.initials: F
authors.lastname: Cengiz
authors.affiliation: Clinic of General Surgery, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Aykas
authors.affiliation: Clinic of General Surgery, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey.
authors.forename: Cenk
authors.initials: C
authors.lastname: Şimşek
authors.affiliation: Clinic of General Surgery, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey.
authors.forename: Göksever
authors.initials: G
authors.lastname: Akpınar
authors.affiliation: Clinic of Pathology, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey.
authors.forename: Nuket
authors.initials: N
authors.lastname: Eliyatkın
authors.affiliation: Clinic of General Surgery, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: Duran
keywords: Rectal cancer; neoadjuvant chemoradiotherapy; recurrence