Background and objective: Preoperative treatment with chemo radiotherapy for rectal cancer is a standard approach for certain patients group with cancer rectum. This study reports on overall survival and disease-free survival, down staging and toxicity in rectal cancer patients who received combined chemo radiation therapy followed by curative surgery. Patients and methods:in oncology department, Bahrain and between December 2009 and November 2012, 30 patients with clinical preoperative stage II–III underwent chemo radiotherapy followed by radical surgery for middle and lower rectal adenocarcinoma. Preoperative radiotherapy (total 50.4 Gy was delivered in 1.8-Gy daily fractions, five times per week over a period of approximately 6 weeks) and chemotherapy (5-fluorouracil 350 mg/m2/day and leucovorin 20 mg/m2/day, bolus on days 1–5 and 29–33). Results: All patients successfully completed the planned treatment course. Pathological complete response (pCR) was found in 5 patients (16.67%). The pathological staging were 12 patientsas stage I, 8 patients were stage II, and 5 patients were stage III. Grade 3 to 4 toxicity occurred in 11 cases (36.67%). Three-year actuarial disease-free survival and overall survival rates were 87.5% and 93.7%, respectively. Local recurrences were found in one patient, 2 patients had distant metastases. Two patients died (1 of cancer related causes), 25were alive and disease free, and 3 are alive with disease. Conclusions: Our center experience showed that preoperative chemo radiotherapy approach seems to improve the disease-free survival and overall survival of selected patients with rectal cancer. However, a longer follow-up time is required to confirm these results and define the failure pattern for our patients with possible palmed factors
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