Abstract
Purpose To assess the influence of preoperative radiation does escalation ± concurrent chemotherapy in patients with advanced rectal cancer. Methods Patients with clinical T3/T4 rectal cancer received preoperative XRT ± chemotherapy, followed by surgery. 74 patients received 45 Gy XRT (low-dose group). 82 patients received 55.8 Gy XRT (high-dose group). 33 patients received 55.8 Gy XRT with concurrent 5-FU chemotherapy (CRT group). The 3 groups were compared with respect to post-radiation pathologic stage, local tumor control (LC), disease-specific survival (DSS), freedom from distant metastasis (FDM), and acute toxicity. Results The high-dose XRT and CRT groups had significantly fewer pT3/4 tumors relative to the low-dose XRT group (53% and 51%vs. 70%, respectively, P 0.005, x2) Conclusions The addition of 5-FU chemotherapy to preoperative XRT results in greater downstaging of clinically fixed tumors than XRT alone. The acute toxicity of CRT is greater than that of XRT alone. Patients with clinically fixed rectal cancer benefit most from preoperative CRT.
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