title: Sequential boost in neoadjuvant irradiation for T3N0-1 rectal cancer: long-term results from a single-center experience.
abstract: OBJECTIVE
  To evaluate the influence of radiation dose on tumor regression grade (TRG) and sphincter preservation rate in a series of cT3N0-1 rectal cancer patients treated with neoadjuvant chemoradiotherapy (CT-RT) with or without a sequential radiation boost.
  
  
  METHODS
  Between May 2002 and September 2013, 116 cases were eligible for retrospective evaluation. Radiotherapy was delivered for a total dose of 45 Gy (no boost arm) or 50.4 Gy (boost arm). TRG was evaluated with the Dworak scale.
  
  
  RESULTS
  Median follow-up was 62 months (range, 12-138 months). The 5-year overall survival and local control rates were 72% and 93%, respectively. Fifty-five patients (47%) were treated with a sequential radiation boost and 61 (53%) without a boost. Eighty patients (72%) presented T3N0 disease and 32 (28%) T3N1 disease. Concomitant capecitabine was administered in 92 cases (79%) and intravenous 5-fluorouracil in 24 cases (21%). Sphincter preservation was performed in 82% of patients in the boost arm and 66% in the no-boost arm. A higher TRG was related to a longer interval between neoadjuvant treatment and surgery (p&lt;0.001). The probability of a TRG ≥2 was 2.5 times higher in the boost arm. A gain in local control, estimated at 4% during the first 3 years after CT-RT, favored the boost arm.
  
  
  CONCLUSIONS
  The long-term results from our single-center experience confirm literature data on the role of a sequential boost in tumor response after neoadjuvant CT-RT in a series of cT3N0-1 rectal cancer patients.
authors.affiliation: Radiation Oncology School, University of Palermo, Palermo - Italy.|Radiation Oncology, Sacro Cuore Don Calabria Hospital, Negrar-Verona - Italy.
authors.forename: Rosario
authors.initials: R
authors.lastname: Mazzola
authors.affiliation: Radiation Oncology, ARNAS Hospital, Palermo - Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ferrera
authors.affiliation: Radiation Oncology, ARNAS Hospital, Palermo - Italy.
authors.forename: Teresa
authors.initials: T
authors.lastname: Cucchiara
authors.affiliation: Radiation Oncology School, University of Palermo, Palermo - Italy.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Figlia
authors.affiliation: Radiation Oncology School, University of Palermo, Palermo - Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Gueci
authors.affiliation: Radiation Oncology, ARNAS Hospital, Palermo - Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Sciumè
authors.affiliation: Statistic Sciences Faculty, University of Palermo, Palermo - Italy.
authors.forename: Gioacchino
authors.initials: G
authors.lastname: Di Paola
authors.affiliation: Pathology Unit, ARNAS Hospital, Palermo - Italy.
authors.forename: Nunzia
authors.initials: N
authors.lastname: Scibetta
authors.affiliation: Sezione di Scienze radiologiche, DIBIMEL, University of Palermo, Palermo - Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Lo Casto
authors.affiliation: Radiation Oncology, ARNAS Hospital, Palermo - Italy.
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Pappalardo
authors.affiliation: Sezione di Scienze radiologiche, DIBIMEL, University of Palermo, Palermo - Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Lagalla
authors.affiliation: Radiation Oncology, Sacro Cuore Don Calabria Hospital, Negrar-Verona - Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Alongi
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery; D000328:Adult; D000368:Aged; D001003:Anal Canal; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000069287:Capecitabine / Q000008:administration & dosage; D059248:Chemoradiotherapy; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D041981:Gastrointestinal Tract / Q000528:radiation effects; D006801:Humans; D007081:Ileostomy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009367:Neoplasm Staging; D059351:Organ Sparing Treatments; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014566:Urogenital System / Q000528:radiation effects
chemical_list: D000970:Antineoplastic Agents; D000069287:Capecitabine; D005472:Fluorouracil