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Preoperative radiotherapy "short course" in rectal cancer in elder patient: low impact on tumor regression

  • A Fattopace1,
  • S Canonico1,
  • A Guida2,
  • D Scala2,
  • F Ruffolo2,
  • F Cremona2,
  • B Pecori3,
  • C Guida4,
  • A Avallone5,
  • M Di Marzo2,
  • F Tatangelo6,
  • A Petrillo7,
  • P Marone8 and
  • P Delrio2
BMC Geriatrics20099(Suppl 1):A25

Published: 1 April 2009


Rectal CancerBrain MetastasisTumor RegressionLymph Node NumberPreoperative Radiotherapy


The aim of the study was to evaluate the impact of preoperative radiotherapy on tumor regression by an assessment of Tumor Regression Grade (TRG) in patients with rectal cancer treated with preoperative short course radiotherapy and then operated on after a medium interval of 30 days.

Materials and methods

From July 2002 to September 2008 31 patients were enrolled: 16 women aged between 65 and 77 (average age 71 years) and 15 males aged between 69 and 85 (average age 77 years) with rectal cancer.

All patients underwent endorectal ultrasound and MRI pre-and post-radiotherapy treatment. Included patients had rectal cancer T2N0 within 5 cm from the anal margin or patients with cancer of the medium rectum T3 N0 or patients with cancer T3N1/T4 deserving preoperative treatment but not fit for a combined chemo-radiotherapy due to co-morbidities.

All patients underwent a short cycle of radiotherapy 5 × 5 Gy (25 fractions) and then were operated after restaging.


Postradiotherapy complications occurred only in 6 patients (19%): local pain (1), tenesmus (1), erythema (2), actinic proctite (2). The medium time between radiotherapy and surgery was almost 30 days. The post-operative mortality was 6% (2 patients): in both cases the exitus was due to heart failure. Pathological examination showed: 1 T3N2G2; 2 T3N1G2; 4 T3N0G2; 3 T2N2G2; 6 T2N0G2; 1 T1N1G2; 10 T1N0G2; 2 T2N1G2; 1 T2N1G1; 1 T0N0G2. Downstaging of the primary tumor occurred in 79.3% of cases. Average examinated lymph nodes number was 42 (range 18–66). TRG analysis showed: 1 TRG 5 (3%); 12 TRG 4 (39%); 9 TRG 3 29%; 8 TRG 2 (26%); 1 TRG 1 (3%).

The 10 N+ patients underwent adjuvant chemotherapy.

At a median follow-up of 38 months (range 2–74) there were: 2 local recurrences (1 treated with abdominalperineal resection), 1 lung metastases, 1 liver metastases, 1 brain metastases. Three of them are undergoing second-line chemotherapy. Four patients have died so far (2 post-operatively, 2 spread disease).


Short radiotherapy followed by a long interval (30 days) and surgery produces a high rate of downstaging but has a low impact on tumor regression.

Authors’ Affiliations

Department of General and Specialistic Surgery, Second University of Naples, Italy, Italy
Colorectal Surgical Oncology, National Institute of Tumors of Naples, Italy
Radiotherapy, National Institute of Tumors of Naples, Italy
Radiotherapy, Hospital G. Moscati of Avellino, Italy
Medical Oncology, National Institute of Tumors of Naples, Italy
Pathology, National Institute of Tumors of Naples, Italy
Radiology, National Institute of Tumors of Naples, Italy
Endoscopy, National Institute of Tumors of Naples, Italy


© Fattopace et al; licensee BioMed Central Ltd. 2009

This article is published under license to BioMed Central Ltd.