title: Preoperative Chemoradiation in Locally Advanced Rectal Cancer: Efficacy and Safety.
abstract: BACKGROUND
  Preoperative chemoradiation (CRT) is considered the standard of care in the management of stage II/III rectal cancer. The aim of this retrospective study was to assess the efficacy and safety of preoperative CRT in our patient cohort with locally advanced rectal adenocarcinoma.
  
  
  METHODS
  Forty patients with cT3-4N0-2M0 adenocarcinoma of the lower (n = 26) and mid/upper (n = 14) rectum were enrolled in this study between 2001 and 2012. Radiotherapy (RT) was given to the pelvis. The median prescribed dose was 45 Gy (daily dose, 1.8 - 2.0 Gy). All patients received chemotherapy concurrently with RT and underwent surgery 6 - 8 weeks after CRT. Low anterior resection (LAR) was achieved in 21 patients. Total mesorectal excision (TME) was performed in 24 patients.
  
  
  RESULTS
  Tumor downstaging (expressed as TN downstaging) was observed in 15 patients (38%); a pathological complete response (pCR) was pathologically confirmed in six of them. In nine out of the 26 (23%) patients with low lying tumors, sphincter preservation (SP) was possible. SP was also possible in all but one patient (13%) who achieved a pCR. In three out of 15 patients (8%) with preoperative sphincter infiltration, SP was achieved. With a median follow-up of 58 months, the 4-year local control (LC), distant metastases-free survival (DMFS), disease-free survival (DFS) and overall survival (OS) rates were 89.7%, 86.9%, 79.5% and 81.2%, respectively. The pretreatment tumor size was predictive of response to preoperative CRT. The response to preoperative CRT did show a significant impact on DFS and on OS. TME resulted in a statistically significant increased DFS rate. No grade 3/4 acute toxicity was reported. Three patients developed grade 3 late side effects.
  
  
  CONCLUSIONS
  Preoperative CRT demonstrates encouraging rates of disease control and facilitates complete resection and SP in advanced rectal cancer with acceptable late toxicity.
authors: Department of Radiation Oncology, University Hospital of Ioannina, Ioannina, Greece.
authors: Evangelia
authors: E
authors: Peponi
authors: Department of Radiation Oncology, University Hospital of Ioannina, Ioannina, Greece.
authors: Vlassios
authors: V
authors: Skloupiotis
authors: Department of Surgery, "Hatzikosta" Community Hospital, Ioannina, Greece.
authors: Dimitris
authors: D
authors: Tsironis
authors: Department of Radiation Oncology, University Hospital of Ioannina, Ioannina, Greece.
authors: Ifigenia
authors: I
authors: Tasiou
authors: Department of Radiation Oncology, University Hospital of Ioannina, Ioannina, Greece.
authors: Antonio
authors: A
authors: Capizzello
authors: Department of Surgery, "Hatzikosta" Community Hospital, Ioannina, Greece.
authors: Chris
authors: C
authors: Tsironis
authors: Department of Surgery, "Hatzikosta" Community Hospital, Ioannina, Greece.
authors: Konstantinos E
authors: KE
authors: Tsimoyiannis
authors: Department of Radiation Oncology, University Hospital of Ioannina, Ioannina, Greece.
authors: Evita
authors: E
authors: Pitouli
authors: Department of Surgery, "Hatzikosta" Community Hospital, Ioannina, Greece.
authors: Evangelos
authors: E
authors: Tsimoyiannis
authors: Department of Radiation Oncology, University Hospital of Ioannina, Ioannina, Greece.
authors: Pericles
authors: P
authors: Tsekeris
keywords: Preoperative chemoradiation; Rectal cancer; Sphincter preservation