PURPOSE: To compare the outcome from preoperative chemoradiation (CXRT) and from @entity1161 ( @entity1161 ) in the treatment of @entity5 in two large, single-institutional experiences. @entity1 AND METHODS: Between 1978 and 1995, 403 @entity1 with localized, nonmetastatic, clinically staged T3 or T4 @entity5 @entity1 were treated with preoperative @entity1161 alone at two institutions. @entity1 at institution 1 (n = 207) were treated with pelvic CXRT exclusively, and @entity1 at institution 2 were treated (except for 8 given CXRT) with pelvic @entity1161 alone (n = 196). In addition, a third group (n = 61) was treated with CXRT at institution 2 between 1998 and 2000 after a policy change. Both institutions delivered 45 Gy in five fractions as a standard dose, but institution 2 used 20 Gy in five fractions in selected cases (n = 26). At both institutions, concurrent chemotherapy consisted of a continuous infusion of @entity1487 ( @entity1487 ) at a dosage of 1500 mg/m(2)/week. The end points were response, sphincter preservation (SP), @entity4557 ( @entity4557 ), pelvic disease control (PC), and @entity1349 ( @entity1349 ). RESULTS: Median follow-up was 63 months for all living @entity1 at institution 1 and in the primary group of institution 2. Multivariate analysis of the @entity1 in these groups showed that the use of concurrent chemotherapy improved @entity5 response (T-stage downstaging, 62% vs. 42%, p = 0.001, and pathologic complete response, 23% vs. 5% p < 0.0001), but did not significantly improve LC, @entity4557 , or @entity1349 . Follow-up for the secondary group at institution 2 was insufficient to allow the analysis of these endpoints. In the subset of @entity1 receiving 45 Gy who had @entity5 < or /=6 cm from the anal verge (institution 1: n = 132; institution 2 primary: n = 79; institution 2 secondary: n = 33), there was a significant improvement in SP with the use of concurrent chemotherapy (39% at institution 1 compared with 13% in the primary group at institution 2, p < 0.0001). A logistic regression analysis of clinical prognostic factors indicated that the use of concurrent chemotherapy independently influenced SP in these @entity5 (p = 0.002). This finding was supported by a 36% SP rate in the secondary group at institution 2. Thus SP increased after the addition of chemotherapy at institution 2. CONCLUSIONS: The use of concurrent @entity1487 with preoperative @entity1161 for T3 and T4 @entity5 independently increases @entity5 response and may contribute to increased SP in @entity1 with @entity5 .

The addition of continuous infusion @entity1487 to preoperative @entity1161 increases @entity5 response, leading to increased sphincter preservation in locally advanced XXXX .

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients', 'PATIENTS'] @entity4557 :: ('MESH:D012008', 'Disease') :: ['RFS', 'relapse-free survival'] @entity1161 :: ('MESH:D011832', 'Disease') :: ['radiation therapy', 'RT'] @entity5 :: ('MESH:D009369', 'Disease') :: ['tumor', 'rectal tumors', 'low rectal cancer', 'rectal cancer', 'low tumors'] @entity1349 :: ('MESH:D011475', 'Disease') :: ['OS', 'overall survival'] @entity1487 :: ('MESH:D005472', 'Chemical') :: ['5-FU', '5-fluorouracil']
@entity5 :: (MESH:D009369,Disease) :: ['rectal cancer']
