Can neoadjuvant radiochemotherapy improve the results of multivisceral resections in advanced XXXX (cT4a).

@entity1 @entity5 @entity189 @entity3
OBJECTIVE: To investigate the influence of neoadjuvant radiochemotherapy (nRCT) in advanced @entity189 (cT4a), the prospectively collected data of all @entity1 treated by extended multivisceral resections during the last 16 years were analysed. METHODS: Between 1985 and 2000, 113 @entity1 with clinical T4a @entity189 (invasion of adjacent organs or structures), were treated by extended multivisceral surgery. In 1995 nRCT was introduced as a standardized treatment modality in cT4a @entity189 and applied in 32 @entity1 . Six weeks after completion of nRCT, resection was performed. In all @entity1 at least one additional organ was removed because of clinically evident @entity5 infiltration. In one third of @entity1 (36/113) more than one organ had to be removed. RESULTS: The rate of curative (R0) resections was 89% (101/113). It was similar in @entity1 with and without nRCT (91 vs. 89%). In 40 (35%) @entity1 histopathological examination could verify @entity5 invasion in adjacent organs (34% with vs. 36% without nRCT). The 3-year rate of locoregional recurrence after R0-resection was 12.7%. In multivariate Cox regression analysis the regional lymph node status was the most important prognostic factor (relative risk 5.8, P = 0.007). Neoadjuvant or adjuvant treatment reduced the risk by factor 0.4 (P = 0.211). The 3-year cancer-related survival rate of all @entity1 with curative resection was 72.9%. It was 89.4% in the series treated with nRCT, while it was only 66.7% in @entity1 with neither neoadjuvant nor adjuvant therapy. The relative risk for @entity1 with lymph node @entity3 was 7.0 (P < 0.001) while it was only 0.2 in @entity1 treated with nRCT (P = 0.049). CONCLUSIONS: Together with curative extended multivisceral resection nRCT can improve prognosis in @entity1 with advanced @entity189 (cT4a).
