title: Pre- and post-surgery treatments in rectal cancer: a long-term single-centre experience.
abstract: BACKGROUND
  Our study evaluated long-term survival outcomes in rectal cancer patients treated with preoperative radiotherapy, and the impact on survival of concomitant and postoperative adjuvant chemotherapy (ctx), among other prognostic factors.
  
  
  METHODS
  The study included 196 patients [median age: 58 years (range: 20-86 years); 63.0% men] with locally advanced rectal carcinoma and, in some cases, resectable liver metastasis. Rates of distant metastasis and local recurrence and of 5-year distant metastasis-free survival (dmfs) and overall survival (os) were determined.
  
  
  RESULTS
  The 5-year os rate was 57.0%, with a median duration of 81.5 months (95% confidence interval: 73.7 months to 89.4 months), and the 5-year dmfs rate was 54.1%, with a median duration of 68.4 months (95% confidence interval: 40.4 months to 96.4 months). Prognostic factors for higher os and dmfs rates were downstaging (p= 0.013 andp= 0.005 respectively), radiotherapy dose (50 Gy vs. 56 Gy or 45-46 Gy, bothp= 0.002), and concomitant ctx use (p= 0.004 andp= 0.001) and type (5-fluorouracil-leucovorin-folinic acid vs. tegafur-folinic acid,p= 0.034 andp= 0.043). Adjuvant ctx after neoadjuvant long-term concomitant chemoradiotherapy (ccrt) and surgery was associated with better 5-year os rates for postoperative T0-T3 disease (p= 0.003) and disease at all lymph node stages (p= 0.001).
  
  
  CONCLUSIONS
  Our findings revealed a favourable survival outcome with long-term fractionated irradiation and concomitant 5-fluorouracil-based ctx, achieving 5-year os and dmfs rates of 57.0% and 54.1% respectively. Preoperative administration of radiotherapy (50 Gy) and postoperative adjuvant ctx were associated with a significant survival benefit. Radiation doses above 50 Gy and the interval between ccrt and surgery had no significant effect on survival.
authors.affiliation: Department of Radiation Oncology, Dr. Lutfi Kirdar Kartal Training and Research Hospital, and.
authors.forename: H
authors.initials: H
authors.lastname: Ozyurt
authors.affiliation: Department of Radiation Oncology, Dr. Lutfi Kirdar Kartal Training and Research Hospital, and.
authors.forename: A S
authors.initials: AS
authors.lastname: Ozden
authors.affiliation: Department of Radiation Oncology, Marmara University Faculty of Medicine, Istanbul, Turkey.
authors.forename: Z
authors.initials: Z
authors.lastname: Ozgen
authors.affiliation: Department of Radiation Oncology, Dr. Lutfi Kirdar Kartal Training and Research Hospital, and.
authors.forename: C
authors.initials: C
authors.lastname: Gemici
authors.affiliation: Department of Radiation Oncology, Dr. Lutfi Kirdar Kartal Training and Research Hospital, and.
authors.forename: G
authors.initials: G
authors.lastname: Yaprak
keywords: Rectal cancer; preoperative chemoradiotherapy; prognostic factors; survival