title: Response to treatment and interval to surgery after preoperative short-course radiotherapy in rectal cancer.
abstract: BACKGROUND
  Preoperative short-course radiotherapy with immediate surgery improves local control in patients with rectal cancer. Tumor responses are smaller than those described with radiochemotherapy. Preliminary data associate this lower response to the short period until surgery. The aim of this study is to analyze the response to preoperative short-course radiotherapy and its correlation with the interval to surgery especially analyzing patients with mesorectal fascia involvement.
  
  
  METHODS
  A total of 155 patients with locally advanced rectal cancer treated with preoperative radiotherapy (5×5Gy) were retrospectively analyzed. Tumor response in terms of rates of complete pathological response, downstaging, tumor regression grading and status of the circumferential resection margin were quantified.
  
  
  RESULTS
  The mean interval from radiotherapy to surgery was 23 days. The rate of complete pathological response was 2.2% and 28% experienced downstaging (stage decreased). No differences between these rates and interval to surgery were detected. Eighty-eight patients had magnetic resonance imaging for staging (in 31 patients the mesorectal fascia was involved).The mean time to surgery in patients with involvement of the fascia and R0 surgery was 27 days and 16 days if R1 (P=.016). The cutoff of 20 days reached the highest probability of achieving a free circumferential resection margin between patients with mesorectal fascia involvement, with no statistically significant differences: RR 3.036 95% CI=(0.691-13.328), P=.06.
  
  
  CONCLUSIONS
  After preoperative short-course radiotherapy, an interval>20 days enhances the likelihood of achieving a free circumferential resection margin in patients with mesorectal fascia involvement.
authors.affiliation: Servicio de Oncología Radioterápica, Hospital Universitario «Reina Sofía», Córdoba, España.
authors.forename: Sonia
authors.initials: S
authors.lastname: García-Cabezas
authors.affiliation: Servicio de Oncología Radioterápica, Hospital Universitario «Reina Sofía», Córdoba, España.
authors.forename: Milagrosa
authors.initials: M
authors.lastname: Rodríguez-Liñán
authors.affiliation: Servicio de Oncología Radioterápica, Hospital Universitario «Reina Sofía», Córdoba, España.
authors.forename: Ana M
authors.initials: AM
authors.lastname: Otero-Romero
authors.affiliation: Servicio de Oncología Radioterápica, Hospital Universitario «Reina Sofía», Córdoba, España.
authors.forename: Carmen M
authors.initials: CM
authors.lastname: Bueno-Serrano
authors.affiliation: Servicio de Cirugía General y Digestiva, Hospital Universitario «Reina Sofía», Córdoba, España.
authors.forename: José
authors.initials: J
authors.lastname: Gómez-Barbadillo
authors.affiliation: Servicio de Oncología Radioterápica, Hospital Universitario «Reina Sofía», Córdoba, España. Electronic address: amalia.palacios.sspa@juntadeandalucia.es.
authors.forename: Amalia
authors.initials: A
authors.lastname: Palacios-Eito
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005205:Fascia / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011300:Preoperative Care; D012004:Rectal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: 5×5Gy; Cirugía diferida; Comorbidity; Comorbilidad; Curso corto; Cáncer de recto; Delay surgery; Pathological response; Radioterapia; Radiotherapy; Rectal cancer; Respuesta patológica; Short course