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 cm 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/m²/day, 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 (12%). the pathologic tumor stages in the remaining patients were: t3n0 (n = 4, 18%), t3n1 (n = 3,14%), t4n0 (n = 9, 41%), and t4n1 (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 (4.3%) and distant metastases in 5 patients (21.7%). it seems that preoperative chemoradiation for locally advanced rectal cancer may provide higher rate of sphincter preservation.