title: Additional chemotherapy and salvage surgery for poor response to chemoradiotherapy in rectal cancers.
abstract: OBJECTIVE
  A proportion of locally advanced rectal cancer patients who receive neoadjuvant chemoradiotherapy (NACRT) are still unresectable. This study was undertaken to assess the outcomes of giving additional chemotherapy to rectal cancer patients with unresectable disease after NACRT.
  
  
  METHODS
  Patients with poor response to NACRT where mesorectal fascia was still involved on MRI and R0 resection was doubtful, received additional four cycles of chemotherapy with either CAPOX or FOLFIRINOX regimen, and the response was reevaluated with MRI and reassessed for surgical resection.
  
  
  RESULTS
  Between June 2012 and December 2014, 50 patients received additional chemotherapy with CAPOX regime (19%, 38%) or FOLFIRINOX (31%, 62%) after CRT. Median number of chemotherapy cycles received was four (range 2-8 cycles). Overall 34 (68%) patients underwent exploration and 31 (62%) underwent R0 resection. The median time to surgery following chemoradiation was 5 months (range 3-18 months). Complete pathological response was seen in seven (22%) patients.
  
  
  CONCLUSIONS
  Patients with poor response to NACRT may be further downstaged using additional chemotherapy so as to achieve R0 resection in 62% of cases.
authors.affiliation: Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India.
authors.forename: Reena
authors.initials: R
authors.lastname: Engineer
authors.affiliation: Department of Medical Oncology, Tata Memorial Centre, Mumbai, India.
authors.forename: Vikas
authors.initials: V
authors.lastname: Ostwal
authors.affiliation: Department of Radiodiagnosis, Tata Memorial Centre, Mumbai, India.
authors.forename: Supreeta
authors.initials: S
authors.lastname: Arya
authors.affiliation: Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India.
authors.forename: Priyamvada
authors.initials: P
authors.lastname: Gupta
authors.affiliation: Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India.
authors.forename: Supriya
authors.initials: S
authors.lastname: Chopra
authors.affiliation: Department of Gastrointestinal Medicine, Tata Memorial Centre, Mumbai, India.
authors.forename: Prachi
authors.initials: P
authors.lastname: Patil
authors.affiliation: Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India.
authors.forename: Sudhir
authors.initials: S
authors.lastname: Jatal
authors.affiliation: Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India.
authors.forename: Avanish
authors.initials: A
authors.lastname: Saklani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D059248:Chemoradiotherapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D012004:Rectal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D016879:Salvage Therapy / Q000379:methods*; D055815:Young Adult
keywords: locally advanced rectal cancers; neoadjuvant chemoradiation; poor response