Intensified neoadjuvant radio-chemotherapy for locally advanced rectal cancer: mono-istitutional experience and long-term results

Background: purpose: the purpose of our study is to demonstrate that intensified neoadjuvant chemo-radiotherapy (crt) treatment in locally advanced rectal cancer (larc), aimed at further enhancing the complete pathological response and local disease control, is feasible and well tolerated. materials and methods: from january 2011 to december 2015, 62 patients (women 21, men 41, mean age 61,5, range 36-84) with larc (ct2-3 cn0-2) were enrolled in our institution. all patients performed an intensified neo-adjuvant crt treatment according to the following scheme: folfox4 induction chemotherapy for 3 cycles, followed by a concomitant radio-chemotherapy, with concomitant boost pelvic radiotherapy to a total dose to the primary of 54 gy and daily continuous infusion of 5-fluorouracil. after 6-8 weeks pts were re-evaluated by means of colonoscopy, body tc and pelvic mri. results: intensified crt compliance was 90%. grade i-ii proctitis according to ctcae v4.0 was 43%, grade iii diarrhea was 10%, grade i-ii genito-urinary toxicity was 29%. eleven patients (19%) had a complete pathological response (pcr), 37 patients had a partial response. sixty patients received surgery, two refused it: sphinctersaving procedure was performed in 85% of patients, miles’ surgery in 15% of them. fifty-nine patients are alive, after a median follow-up time of 43 months. six patients experienced a distant metastatic disease, and two patients a local relapse. conclusion: this study has shown that the intensification of preoperative systemic therapy, together with intensification of radiotherapy, was feasible, well tolerated and has obtained high rates of local disease control (96,5%), with 19% of pcr rate.