Preoperative Radiotherapy For Rectal Cancer Research Articles

Preoperative radiotherapy for rectal cancer: A bibliometric analysis of the 100 most-cited research articles.

Preoperative long-course radio-chemotherapy (LC-RCHT) or preoperative short-course radiotherapy (SC-RT) are widely used in the treatment of locally advanced rectal cancer (LARC). This study aimed to evaluate the 100 most-cited research articles focused on preoperative radiotherapy for rectal cancer to reveal existing academic trends and the direction of therapeutic research. This was a retrospective study based on publicly accessible data. The Web of Science database was used to identify the 100 most-cited articles. The median values for total citation and average citation per year (CPY) were 240.50 (range, 150-3787) and 17.32 (5.03-222.76), respectively. Randomized (median: 24.88 vs 13.32, P = 0.001) and funded (median: 27.33 vs 14.73, P = 0.002) studies had more CPY than those with opposite characteristics. No significant difference was found between studies using SC-RT and LC-RCHT, in terms of average CPY (median: 15.27 for SC-RT vs 18.36 for LC-RCHT, P = 0.303). In terms of the primary aim of the investigation, studies investigating non-operative treatment strategies had higher CPY than those investigating other subcategories (p = 0.029). Randomized studies, funded studies, and studies investigating non-operative treatment were associated with more CPY. There remains equal interest in preoperative SC-RT and LC-RCHT for rectal cancer.

Identifying the long-term survival beneficiary of preoperative radiotherapy for rectal cancer in the TME era

This study was to verify the long-term survival efficacy of preoperative radiotherapy (preRT) for locally advanced rectal cancer (LARC) patients and identify potential long-term survival beneficiary. Using the Surveillance, Epidemiology, and End Results (SEER) database, 7582 LARC patients were eligible for this study between 2011 and 2015 including 6066 received preRT and 1516 received surgery alone. Initial results showed that preRT prolonged the median overall survival (OS) of LARC patients (HR 0.86, 95% CI 0.75–0.98, P < 0.05), and subgroup analysis revealed that patients with age > 65 years, stage III, T3, T4, N2, tumor size > 5 cm, tumor deposits, and lymph nodes dissection (LND) ≥ 12 would benefit more from preRT (all P < 0.05). A prognostic predicting nomogram was constructed using the independent risk factors of OS identified by multivariate Cox analysis (all P < 0.05), which exhibited better prediction of OS than the 8th American Joint Cancer Committee staging system on colorectal cancer. According to the current nomogram, patients in the high-risk subgroup had a shorter median OS than low-risk subgroup (HR 2.62, 95% CI 2.25–3.04, P < 0.001), and preRT could benefit more high-risk patients rather than low-risk patients. Hence, we concluded that preRT might bring long-term survival benefits to LARC patients, especially those with high risk.

Laparoscopic synchronous resection of rectal cancer and liver metastases: A case report and review of the literature.

Introduction and importanceDuring the past decade, there are several studies which showed the advantages of the laparoscopic approach for treating colorectal cancer (CRC) or colorectal cancer liver metastasis (CRCLM). However, in contrast, there are only a few reports of combined one stage synchronous laparoscopic colorectal and liver metastasis resection, cold one stage minimally invasive approach (MIA).Case presentationOur patient was 51 years old woman.Rectal adenocarcinoma was verified three centimeters from the anal verge. Magnetic resonance imaging (MRI) with rectal protocol modification indicated T1N0MO stage. We decided to do transanal local excision and achieved R0 resection. Half a year after the operation on the control MRI, lymphadenopathy was found along the rectum and possible recurrence of cancer. Also on the MRI was shown solitary, 4.7 × 2.7 × 3.8 cm big metastasis in the IVa/VIII segment of the liver. The patient was shown on a multidisciplinary team and it was decided to do laparoscopic synchronous resection of rectum and liver metastases.Clinical discussionDuring the last decades many articles with different strategies for treating CRC and liver metastasis were published. Some of them prefered two-stage surgical treatment, like liver first approach which allows initial control of liver metastases, and delivery of preoperative radiotherapy for rectal cancer without the fear that liver metastases will meanwhile progress beyond the possibility of cure. Alternatively, the colon first approach is where the adjuvant chemotherapy is combined with the resection of the primary colorectal tumour with liver resection being undertaken (if at all) as a subsequent operation. By developing surgery, anaesthesia and critical care, the one stage approach for patients with CRC and liver metastasis started to be a reasonable option.ConclusionTotally laparoscopic synchronous resection of the colorectal cancer and synchronous colorectal liver metastasis is technically feasible and safe in the hands of the experienced abdominal surgeon. This type of approach offers all the benefits of the laparoscopic minimally invasiveness associated with good oncological outcomes, and it is indicated in well-selected patients. However, the real scientific answer to this question can be given just with randomised control trial which will be a real challenge for endoscopic surgeons in the future.

P-225 Clinico-epidemiological and therapeutic profile of rectal cancer: Experience of the department of radiation oncology EHSO ORAN

The aim of our study was to analyze the epidemiological, clinical and therapeutic profile and evaluate the value of preoperative radiotherapy in rectal cancer. Our cohort included 186 cases of locally advanced rectal cancer managed in our department from January 2016 to December 2019 for preoperative radiotherapy. One hundred patients (53.8%) received induction chemotherapy followed by concomitant chemoradiotherapy, 40 (21.5%) received concomitant chemoradiotherapy, 31 (16.7%) received exclusive radiotherapy and 15 (8.1 %) received induction chemotherapy followed by exclusive radiotherapy. Radiotherapy was conformational three-dimensional. The median age was 58 years (range 23-92 years) with 63.4% men and 36.6% women. The symptomatology was dominated by rectal bleeding described by one hundred and forty-six (78.5%) patients. It was a liberkhunian adenocarcinoma in 95.2%. One hundred and sixty patients (86%) were stage III, 14 (7.5%) stage II, and 12 (6.5%) stage IV according to the American Joint Committee on Cancer (AJCC). One hundred and thirteen patients (60.8%) were operated on. The post-operative histological response was a complete response in 23% of cases, and stages 0, I, II and III in 0.9%, 35.4%, 17.7% and 23%, respectively. Fifty-six patients (30.1%) received adjuvant chemotherapy. The median follow-up was 31 months (3-64 months). Ten patients (8.8%) had a locoregional relapse while 25 (22.1%) had metastasized. The two years locoregional recurrence-free survival rate was 93.1% and overall survival rate was 83%. Rectal cancer is a common pathology. Its treatment is multidisciplinary (surgery, radiotherapy and chemotherapy). Preoperative radiotherapy of locally advanced forms allows better locoregional control but has no impact on overall survival.

Comparison of dosimetric characteristics between flattening filter‐free and flattening filter mode volumetric‐modulated arc therapy plans in rectal cancer

AbstractObjectiveWe aimed to compare the dosimetric characteristics of 6‐MV flattening filter mode (FF) and flattening filter‐free mode (FFF) volumetric‐modulated arc therapy (VMAT) plans in preoperative radiotherapy for rectal cancer using an Edge linear accelerator.MethodsTwo‐arc FF‐VMAT and FFF‐VMAT plans were generated for 15 patients with rectal cancer using the Philips Pinnacle treatment planning system (version 9.10). The homogeneity index, conformity index, planning target volume covered by 105% isodose lines, organ‐at‐risk dosimetry characteristics, and monitor units (MUs) were compared between the plans. The results were analyzed using paired t‐tests.ResultsThe conformity index of the FF‐VMAT plan and FFF‐VMAT plan were (0.93 ± 0.01) and (0.92 ± 0.02), and the homogeneity index of the two groups were (0.07 ± 0.03) and (0.08 ± 0.01), the differences were not statistically significant (both P &gt; 0.05). The volume covered by 105% isodose lines of the FFF‐VMAT plan was significantly higher than that of the FF‐VMAT plan. The FFF‐VMAT plan required a higher monitor unit (t = 11.49, P = 0.002) and shorter beam‐on time (t = 5.78, P = 0.001) compared with the FF‐VMAT plan. There were no significant differences in the absolute volume receiving 30 Gy and 40 Gy of the bladder between the plans. The absolute volume receiving 30 Gy and absolute volume receiving 40 Gy of the intestine and colon in the FFF‐VMAT plan increased by 5.5% and 2.1% compared with those in the FF‐VMAT plans that increased by 7.2% and 2.2%, respectively (both P &gt; 0.05). The absolute volume receiving 20 Gy of the left and right femoral head in the FFF‐VMAT plan decreased by 3.7% and 4.9% compared with those in the FF‐VMAT plans (P &gt; 0.05).ConclusionBoth FF‐VMAT and FFF‐VMAT plans met the clinical requirements.

Effect of preoperative radiotherapy for rectal cancer on spermatogenesis.

In this study, preoperative radiotherapy for rectal cancer was found to result in a dose-dependent impairment of spermatogenesis and Sertoli cell function, reflected both by decreased sperm count and characteristic changes in hormonal response, with signs of partial recovery between 12 and 24 months after surgery. Decreased semen volume was also observed, indicating ejaculatory tract dysfunction, that seemed to be longer-lasting and not related to testicular dose. This threatens fertility in men treated for rectal cancer, and suggests that pretreatment cryopreservation and anticonception after treatment should be discussed individually.

Correction: Developing a Raman spectroscopy-based tool to stratify patient response to pre-operative radiotherapy in rectal cancer.

Correction for 'Developing a Raman spectroscopy-based tool to stratify patient response to pre-operative radiotherapy in rectal cancer' by Chloe J. Kirkby et al., Analyst, 2021, 146, 581-589, DOI: .

Developing a Raman spectroscopy-based tool to stratify patient response to pre-operative radiotherapy in rectal cancer

Rectal cancer patients frequently receive pre-operative radiotherapy (RT), prior to surgical resection. However, colorectal cancer is heterogeneous and the degree of tumour response to pre-operative RT is highly variable. There are currently no clinically approved methods of predicting response to RT, and a significant proportion of patients will show no clinical benefit, despite enduring the side-effects. We evaluated the use of Raman spectroscopy (RS), a non-destructive technique able to provide the unique chemical fingerprint of tissues, as a potential tool to stratify patient response to pre-operative RT. Raman measurements were obtained from the formalin-fixed, paraffin-embedded (FFPE) pre-treatment biopsy specimens of 20 rectal cancer patients who received pre-operative RT. A principal component analysis and linear discriminant analysis algorithm was able to classify patient response to pre-operative RT as good or poor, with an accuracy of 86.04 ± 0.14% (standard error). Patients with a good response to RT showed greater contributions from protein-associated peaks, whereas patients who responded poorly showed greater lipid contributions. These results demonstrate that RS is able to reliably classify tumour response to pre-operative RT from FFPE biopsies and highlights its potential to guide personalised cancer patient treatment.

The Impact of Surgeons on Likelihood of Preoperative Radiotherapy in Rectal Cancer

Guideline concordant care for patients with clinical stage II/III rectal cancer includes radiation therapy prior to surgery, yet a large proportion of rectal cancer patients do not receive radiation. This study sought to determine the impact of surgeons on the receipt of radiation among a population-based cohort of rectal cancer patients. We identified Medicare beneficiaries with a confirmed diagnosis of stage II or III rectal cancer diagnosed between 2004 and 2013. From claims data we identified the surgeon performing definitive rectal cancer surgery, and determined whether patients received preoperative radiotherapy. We used multivariable logistic mixed effects models to identify factors associated with receipt of radiation prior to surgery, using odds ratios (OR) to describe the influence of patient demographic and clinical covariates and the median OR (MOR) to compare the impact of individual surgeons on the likelihood of patients receiving preoperative radiation. Of the 2,596 rectal cancer patients identified, 1,233 (47%) received radiation treatment. The likelihood of receiving radiation depended substantially on the treating surgeon. Dividing surgeons into quintiles by likelihood of their patients receiving pre-operative radiation produced rates of radiation therapy ranging from 0% among the lowest quintile of surgeons to 87% in the top quintile. On multivariable analysis, the individual surgeon retained their importance on determining the likelihood of a patient receiving radiation with a MOR of 1.85 (95% confidence interval [CI] 1.59, 2.80). The surgeon had a greater impact on patients receiving radiation than all other patient factors aside from patient age (OR for age 65-69 versus 80+ 3.10 95% CI 2.39, 4.02). Among providers, the rates of pre-operative radiation were higher among specialists compared to general surgeons (OR 1.62; 95% CI 1.26, 2.07), and more experienced surgeon compared to less experienced (OR for graduated from medical school after 1990 versus 1970-1980 1.77; 95% CI 1.17, 2.69). Patient marital status, race, income, geographic region, provider training (US vs non-US), and provider surgery volume did not significantly impact odds of radiation therapy. This study demonstrates that the individual surgeon substantially impacts the likelihood that rectal cancer patients will receive radiotherapy prior to surgery. Further research should evaluate provider biases, gaps in education, or interventions among surgeons to increase the use of radiation therapy in rectal cancer.

Gender differences in stage at diagnosis and preoperative radiotherapy in patients with rectal cancer

BackgroundFew studies have examined gender differences in the clinical management of rectal cancer. We examine differences in stage at diagnosis and preoperative radiotherapy in rectal cancer patients.MethodsA prospective cohort study was conducted in 22 hospitals in Spain including 770 patients undergoing surgery for rectal cancer. Study outcomes were disseminated disease at diagnosis and receiving preoperative radiotherapy. Age, comorbidity, referral from a screening program, diagnostic delay, distance from the anal verge, and tumor depth were considered as factors that might explain gender differences in these outcomes.ResultsWomen were more likely to be diagnosed with disseminated disease among those referred from screening (odds ratio, confidence interval 95% (OR, CI = 7.2, 0.9–55.8) and among those with a diagnostic delay greater than 3 months (OR, CI = 5.1, 1.2–21.6). Women were less likely to receive preoperative radiotherapy if they were younger than 65 years of age (OR, CI = 0.6, 0.3–1.0) and if their tumors were cT3 or cT4 (OR, CI = 0.5, 0.4–0.7).ConclusionsThe gender-specific sensitivity of rectal cancer screening tests, gender differences in referrals and clinical reasons for not prescribing preoperative radiotherapy in women should be further examined. If these gender differences are not clinically justifiable, their elimination might enhance survival.

Preoperative Radiotherapy in Rectal Cancer

Rectal cancer is the third most common types cancer in the world and rank second as a cause of cancer related deaths in 2018. Surgical is the main modality in treatment of rectal cancer, however preoperative radiotherapy significantly reduces local recurrence risk after surgery. At present there are two different schedules of preoperative radiotherapy, short-course preoperative radiotherapy (25 Gy at 5 fractions) followed by immediate surgery and long-course chemoradiotherapy (45-50 Gy at 25-28 fractions) followed by delayed surgery. Although the purpose and local control rate of both schedules is the same, it is indicated in different conditions.

Dose–time fractionation schedules of preoperative radiotherapy and timing to surgery for rectal cancer

Chemoradiotherapy (CRT) is extensively used prior to surgery for rectal cancer to provide significantly better local control, but the radiotherapy (RT), as the other component of CRT, has been subject to less interest than the drug component in recent years. With considerable developments in RT, the use of advanced techniques, such as intensity-modulated radiotherapy (IMRT) in rectal cancer, is garnering more attention nowadays. The radiation dose can be better conformed to the target volumes with possibilities for synchronous integrated boost without increased complications in normal tissue. Hopefully, both local recurrence and toxicities can be further reduced. Although those seem to be of interest, many issues remain unresolved. There is no international consensus regarding the radiation schedule for preoperative RT for rectal cancer. Moreover, an enormous disparity exists regarding the RT delivery. With the advent of IMRT, variations will likely increase. Moreover, time to surgery is also quite variable, as it depends upon the indication for RT/CRT in the clinical practices. In this review, we discuss the options and problems related to both the dose–time fractionation schedule and time to surgery; furthermore, it addresses the research questions that need answering in the future.

Bevacizumab is associated with delayed anastomotic leak after low anterior resection with preoperative radiotherapy for rectal cancer: a case report

BackgroundBevacizumab is an anti-angiogenesis agent used to treat patients with metastatic colorectal cancer and is associated with a variety of complications. We present a patient with rectal cancer who developed a delayed anastomotic leak more than 5 years after undergoing low anterior resection.Case reportA 78-year-old man with hematochezia was diagnosed with two synchronous rectal cancers 7 years prior to presentation. Preoperative chemo-radiotherapy was given followed by a very low anterior resection. During follow-up, multiple lymph node metastases developed, which were treated with chemotherapy. First-line chemotherapy, capecitabine, oxizaliplatin, and bevacizumab, was given over 3 years, and second-line chemotherapy, capecitabine, irinotecan, and bevacizumab, was administered over a 3-month period. After the last treatment, the patient presented with pneumaturia and fecaluria. Computed tomography scan revealed extraluminal air between the prostate and rectum, adjacent to the anastomotic site. Ulceration and fistula formation were observed on colonoscopy, and contrast radiography demonstrated a fistula at the anastomotic site. An anastomotic-urethral fistula was diagnosed and transverse colostomy was performed.ConclusionsThis patient highlights a rare late adverse event at the anastomotic site associated with bevacizumab treatment and preoperative chemo-radiotherapy. Signs and symptoms suggesting anastomotic complications should be thoroughly evaluated during bevacizumab treatment, even long after surgical resection.

A Phase I/ II Feasibility Study of Intravenous Cetuximab in Combination with 5 days Weekly Oral Capecitabine and Preoperative Radiotherapy in Rectal Cancer (XERXES)

Background Preoperative Long-course chemoradiation (LCCRT) is the standard-of-care in locally advanced rectal cancer (LARC). This phase I/II trial in two sequential studies aimed to evaluate the activity and safety of the anti-epidermal growth factor receptor (EGFR) monoclonal antibody cetuximab administered weekly-prior to, and following LCCRT. Patients and Methods All patients had magnetic resonance imaging (MRI) defined cT3/cT4 or node-positive rectal adenocarcinoma and treatment with LCCRT (capecitabine 825 mg/m2 bid on Monday-Friday for 5 weeks during radiotherapy [45Gy in 25 daily fractions] followed by total mesorectal excision (TME). In Phase I patients received weekly induction cetuximab 400mg/m2 loading, then 250mg/m2 once weekly for 4 weeks prior to standard LCCRT. In phase II 10 patients were randomised to receive: arm A standard LCCRT alone or arm B (sandwich) LCCRT with additional induction cetuximab 250mg/m2 weekly prior to LCCRT and consolidation for 5 weeks following. Results In Phase I all 12 patients proceeded to surgery with a single pCR (8%) reported. This pCR rate together with acceptable compliance (100%) and toxicity (4 Grade 3 toxicities, 2 skin rash, 1 pain and 1 pulmonary embolus) and the absence of severe surgical complications allowed continuation to phase II. In Phase II, 10 patients were recruited and five patients were randomly assigned to each treatment arm. One additional patient allocated cetuximab/CRT chose to withdraw from the trial and received no treatment. In Arm B 4/5 patients proceeded to surgery with one pCR compared to three of five patients proceeding to surgery with two achieving pCR in Arm A. The Trial closed after studies in metastatic disease reported efficacy depended on selection according to K-RAS/NRAs mutational status. Conclusions: In unselected patients without enrichment according to KRAS/NRAS/BRAF status, the addition of induction and consolidation cetuximab to pre-operative LCCRT provided modest efficacy with good compliance and manageable toxicity.

A novel dynamic arc treatment planning solution to reduce dose to small bowel in preoperative radiotherapy for rectal cancer

Preoperative radiotherapy or combined chemoradiotherapy for locally advanced rectal cancer (LARC) can cause acute and late gastrointestinal (GI) side-effects. There is thought to be a dose-volume relationship between small bowel irradiation and the development of these effects. A planning study was undertaken to compare small bowel sparing for a range of 3D conformal and dynamic arc planning solutions. A planning study was carried out for 20 LARC patients. Organs at risk (OAR) contoured included bowel loops and peritoneal space (PS). For each of the 20 patients, 5 plans were created: (1) standard 3D conformal plan; (2) standard dual dynamic arc plan; (3) dual dynamic arc plan with 90° avoidance sector through the anterior portion of the patient; (4) dual dynamic arc plan with an anterior avoidance structure in the optimizer; (5) dual dynamic arc plan with both an anterior avoidance structure and an avoidance sector. The prescription was 50.4 Gy in 28 fractions to the planning target volume (PTV). Five Dose Volume Levels (DVLs; V15 Gy, V20 Gy, V25 Gy, V35 Gy, V40 Gy, and V50.4 Gy) for bowel and PS were selected. The DVLs were compared between the plans using Friedman Tests and Wilcoxon Signed Rank Tests. Comparison of the 5 plans revealed that a dual dynamic arc plan containing both an anterior avoidance sector and structure significantly improved the dose to the bowel compared to a standard 3D conformal plan and to a standard dual dynamic arc plan. This improvement was achieved while maintaining PTV coverage. This novel dual dynamic arc planning technique that uses both an avoidance sector and structure reduces the dose to the bowel and PS, which may lead to a reduction in GI toxicity.

The Use of DRR Designed Fields Is Unnecessarily Toxic and Geographically Inadequate, Analysis of Drr Designed Fields in Preoperative Radiotherapy in Rectal Cancer

The Use of DRR Designed Fields Is Unnecessarily Toxic and Geographically Inadequate, Analysis of Drr Designed Fields in Preoperative Radiotherapy in Rectal Cancer

Short-course versus Long-Course Preoperative Radiotherapy in Rectal Cancer: an Evidence Based Case report

Background Surgery is the mainstay therapy for colorectal carcinoma with curative intent, while radiotherapy and chemotherapy act as adjuvant or neoadjuvant therapy. The desicion for surgery depends on tumor resectability. Neoadjuvant radiotherapy, both short-course radiotherapy (SRT) or long-course radiotherapy (LRT) with or without concurent chemtherapy, is aimed to increase tumor resectability. This article compares advantages of SRT and LRT. Method We designed a search filter using relevant synonyms for the domain: “rectal carcinoma”, “resectable”, “preoperative radiotherapy”, and “short-course”. Publications are retrieved from PubMed, Cochrane Library, and EBSCO using MESH terms and search terms in title and abstract fields. Articles’ titles and abstracts from search result are screened for relevance. Eligible articles are selected based on inclusion and exclusion criterias. Selected articles are critically appraised for methods validity. Result Six articles are included in our study, consists of four randomized clinical trials and four metaanalyses. Conclusion SRT is as effective as LRT with or without chemotherapy in terms of overall survival, disease free survival, local recurrence rate, disease metastasis rate, free resection rate, and grade 3-4 toxicity. LRT with or without chemotherapy showed superiority in increasing pathological complete response rate and sphincter preservation rate. SRT is a better choice in centers with a long waiting list.

P-316 - Is there any association of dose received by pelvic bone marrow in preoperative radiotherapy in rectal cancer with hematological toxicity of subsequent oxaliplatin-based chemotherapy?

P-316 - Is there any association of dose received by pelvic bone marrow in preoperative radiotherapy in rectal cancer with hematological toxicity of subsequent oxaliplatin-based chemotherapy?

PO-1065: Role of CT-MRI co-registration in tumor delineation for preoperative radiotherapy of rectal cancer

PO-1065: Role of CT-MRI co-registration in tumor delineation for preoperative radiotherapy of rectal cancer

Phase I and II trial on infusional 5-fluorouracil and gefitinib in combination with preoperative radiotherapy in rectal cancer: 10-years median follow-up

PurposeThe aim of this study is to evaluate the long term survival of the addition of gefitinib to chemoradiotherapy (CRT) in locally advanced rectal cancer (LARC). Methods and materialsThis previously published multicentre, open-label, phase I-II study, enrolled patients (pts) with LARC to receive CRT with concurrent 5-fluorouracil continuous intravenous infusion and a dose escalation of orally administered gefitinib, followed 6–8 weeks later by surgery. An intra-operative radiotherapy boost of 10 Gy was planned. Adjuvant chemotherapy was administrated in ypN1-2 pts. After a median f/u of >10 years, we analyzed Local Control (LC), Metastasis Free Survival (MFS), Disease Free Survival (DFS), Disease Specific Survival (DSS) and Overall Survival (OS). Predictive endpoints of clinical outcomes were tested by univariate and multivariate analysis. Variables analyzed included: age, gefitinib dose and interruptions, adjuvant CT, surgery type, ypT, ypN, and TRG grade. We have also analyzed late toxicity according to CTCAEv4. ResultsOf the 41 initially enrolled pts, 39 were evaluable (27M, 12F). With a median f/u of 133 months, LC, MFS, DFS, OS and DSS at 5 years were 84%; 71%; 64%; 87% and 92%, respectively. The OS and DSS at 10 years were 61,5% and 76%, respectively. Grade 3-4 late toxicity occurred in 38% of pts: sexual (28,2%) and gastrointestinal toxicities (10,2%). ConclusionLong term outcomes and late toxicity were similar to previously reported series. The addition of gefitinib did not improve outcomes in LARC. Gefitinib is not recommended for rectal cancer patients who received 5-FU based preoperative CRT. Further studies may identify if gefitinib is beneficial in selected group of patients.