Is neoadjuvant chemotherapy prior to radio-chemotherapy beneficial in T4 XXXX ?

@entity1 @entity5 @entity900 @entity189 @entity1487
BACKGROUND: This study retrospectively describes the outcome of a series of 38 @entity1 (pts) with T4 @entity189 exclusively treated by radio and chemotherapy. @entity1 AND METHODS: From 1992 to 2007, 38 pts with UST4-N0-2-M0 @entity189 were treated with exclusive radiotherapy and chemotherapy. All @entity1 received external beam radiotherapy (EBRT) (median dose 45   Gy) with a concomitant chemotherapy (5- @entity1487 - @entity900 ). Eleven @entity1 received neo-adjuvant chemotherapy (5- @entity1487 - @entity900 ). After 2-8 weeks, a 15-20   Gy boost was delivered either with EBRT (20 pts) or interstitial (192)Ir brachytherapy (18 pts). Mean follow-up was 66 months. RESULTS: After chemoradiation therapy (CRT), 13 pts (34%) had a complete response, 23 pts (60%) a response >50% (2 pts were not evaluated). The 5-year-disease-free survival was 79.2        6.5%, and the 5-year overall survival was 83.9        6%. Eight @entity1 developed @entity5 progression (mean delay 8.8 months), six of them requiring a salvage surgery with definitive colostomy for local relapse. Late severe complication requiring colostomy was observed in 2 pts. The 5-year-colostomy-free survival was 78        6.9%. @entity1 who received primary chemotherapy had a statistically significant better 5-year colostomy-free survival (100% vs. 38        16.4%, P   =   0.0006). CONCLUSION: T4 @entity189 can be treated with a curative intent using a sphincter-sparing approach of CRT, and neo-adjuvant chemotherapy should be considered prior to radiotherapy.
