- Preoperative radio-chemotherapy (RCT) may play an important role in decreasing local recurrence and possibly improving survival for patients with advanced rectal carcinoma. Between 1995 and 1998 we treated 30 patients (pts) (median age 61.5 years) with advanced low rectal cancer. Radiotherapy was administered using a 10-MV linear accelerator delivering a total dose of 45 Gy to the pelvis over 5 weeks. 5-FU (500 mg/m2/d i.v.) was given concomitantly on days 1-3 and 29-31. Surgery was performed 2-4 weeks after RCT and included abdomino-perineal resection (APR) in 15 pts, anterior resection in 11 pts, transanal resection in 1 pt, and explorative laparotomy in 1 pt; 2 pts refused surgery. There were no serious toxicities associated with RCT. Mild to moderate transient radiation dermatitis was noted in 3 pts, and grade II diarrhea in 4 pts. Postoperative pathologic staging was as follows: no tumor found (CR): 4 pts, MAC B1 (T2N0M0): 5 pts, MAC B2 (T3N0M0): 17 pts, B3 (vaginal involvement): 1 pt, MAC C2 (T3N1M0): 2 pts, and MAC D: 1 pt. Necrosis and/or fibrosis was noted as a prominent histopathologic feature. Preoperative RCT in this series of 30 pts with advanced rectal cancer was well tolerated and associated with a high response rate (13% CR, 17% PR, 57% NC). 5-year overall survival was 70%, and 8-year survival was 58%.