Combined preoperative chemotherapy and radiation for locally advanced rectal carcinoma

To determine the efficacy of combined preoperative chemotherapy and radiati on therapy for locally advanced rectal carcinoma and the rate of sphincter conservation, a retrospective survey of 39 patients with locally advanced r ectal carcinoma treated with various 5-fluorouracil- and leukovorin-based c hemotherapy regimens and radiation prior to surgery in a single institution was reviewed. Toxicity, local control and survival were evaluated and comp ared to previous studies with similarly staged patients. Long-term follow-u p was available on 35 patients. The actuarial local failure was 5.7% while the actuarial 5-year survival was 87%. The mortality rate was low (2.5%) an d the rate of long-term serious complications acceptable (11.4%). Combined preoperative chemotherapy and radiation provided excellent local regional c ontrol despite the poor prognostic factors associated with size, fixation, and the initial advanced tumor stage with acceptable morbidity. In addition , patients with tumors located in the lower third of the rectum may be able to undergo sphincter-sparing surgery. Although the median follow-up is rel atively short (32.4 months), the results are in accordance with previous st udies of neoadjuvant combined chemotherapy and radiation for locally advanc ed rectal carcinoma in terms of local and distant control.