PREOPERATIVE CHEMORADIATION FOR LOCALLY ADVANCED LOW LYING RECTAL CANCER: PRELIMINARY RESULTS

Optimal management of low lying locally advanced rectal cancer remains a major challenge. this study was performed to evaluate the impact of preoperative external radiation therapy combined with systemic chemotherapy on sphincter preservation and local control in locally advanced low lying «5 em from anal verge) rectal cancer. a total of 25 consecutive patients with biopsy proven locally advanced low lying rectal cancer were treated with preoperative 5fu (750 mg/mvday, first and fifth week of radiation) and external beam radiation (45 gy in 25 fractions over 5 weeks) followed by radical resection. surgery was performed 4-6 weeks after the end of chemoradiation. there was no major acute toxicity following chemoradiation and all patients completed their scheduled preoperative therapy. a complete pathologic response to preoperative chemoradiation was confirmed in 3 patients (120/0). the pathologic tumor stages in the remaining patients were: t3no (n = 4, 180/0), t3nl (n = 3,14%), t4no (n = 9, 410/0), and t4nl (n = 6, 27% ). eighteen patients (72%) had a sphincter saving surgical procedure but sphincter was finally preserved in 16 patients (64% ). a perfect continence was achieved in 85% of cases. there were 2 (8%) perioperative mortality and 9 (36%) perioperative morbidity. in 3 (12%) patients a reoperation was required. at a median follow up of 27 months, local recurrence was observed in 1 patient (4.30/0) and distant metastases in 5 patients (21.70/0). it seems that preoperative chemoradiation for locally advanced rectal cancer may provide higher rate of sphincter preservation.