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Modified neoadjuvant short-course radiation therapy in uT3 rectal carcinoma: low local recurrence rate with unchanged overall survival and frequent morbidity

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study is to investigate the value of a modified neoadjuvant short-course radiation therapy (SCRT) in uT3 rectal carcinoma, which, despite local R0 resectability, carries a greater risk of local recurrence than less invasive carcinomas.

Methods

Sixty-three patients with uT3 rectal carcinoma ≤10 cm above the anal verge received a modified 8 × 3 Gy pre-operative SCRT. Radiation-associated and peri-operative complications were recorded, and the patients were followed up for long-term oncological outcome and morbidity.

Results

In the study group, there were no severe adverse radiation-associated effects; the rate of peri-operative morbidity was 54.0% and that of in-hospital mortality is 4.8%. The probability (Kaplan–Meier estimate) of local recurrence was 3.9% with a probability of metachronic distant metastases of 26.8% (5-year rates). We found the probability of 5-year disease-free survival to be 70.5% and that of 5-year overall survival, 59.5%. Long-term complications were reported for 31.7% of patients.

Conclusions

Compared to the literature-modified 8 × 3 Gy neoadjuvant SCRT and surgery in uT3, rectal carcinoma was associated with low local recurrence but frequent peri-operative complications. The decisive prognostic factor, distant metastasis, was unaffected. Difficulties included overestimation of tumour invasion depth by endosonography. Possible clinical consequences of the results are discussed.

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Authors and Affiliations

  1. An-Institut für Qualitätssicherung in der operativen Medizin (gGmbH) an der Otto-von-Guericke Universität Magdeburg (An-Institut), Leipziger Str. 44, 39120, Magdeburg, Germany

    Rainer Kube, Henry Ptok, David Jacob, Jörg Fahlke, Pawel Mroczkowski, Hans Lippert & Ingo Gastinger

  2. Chirurgische Klinik, Carl-Thiem-Klinikum Cottbus, Cottbus, Germany

    Henry Ptok, David Jacob & Ingo Gastinger

  3. Abteilung Strahlentherapie, Radiologisches Institut, Carl-Thiem-Klinikum Cottbus, Cottbus, Germany

    Gunther Ziegenhardt

  4. Klinik für Allgemein, Viszeral- und Gefäßchirurgie Universitätsklinikum A.ö.R., Magdeburg, Germany

    Rainer Kube, Jörg Fahlke, Pawel Mroczkowski & Hans Lippert

  5. StatConsult, Magdeburg, Germany

    Uwe Schmidt

  6. Klinik für Allgemein-, Viszeral- u. Gefäßchirurgie, Universitätsklinikum Magdeburg, Haus 60a, Leipziger Str. 44, 39120, Magdeburg, Germany

    Rainer Kube

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  1. Rainer Kube
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Correspondence to Rainer Kube.

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Kube, R., Ptok, H., Jacob, D. et al. Modified neoadjuvant short-course radiation therapy in uT3 rectal carcinoma: low local recurrence rate with unchanged overall survival and frequent morbidity. Int J Colorectal Dis 25, 109–117 (2010). https://doi.org/10.1007/s00384-009-0823-y

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  • DOI: https://doi.org/10.1007/s00384-009-0823-y

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