Préoperative hyperfractionated accelerated radiotherapy (HART) in locally advanced rectal cancer (LARC) immediately followed by surgery. A prospective trial.

Abstract
Background and purpose: We aim to report on local control in a phase II trial on preoperative hyperfractionated and
accelerated radiotherapy schedule (HART) in locally advanced resectable rectal cancer (LARC). This fractionation
schedule was designed to keep the overall treatment time (OTT) as short as possible.
Patients and methods: This is a prospective trial on patients with UICC stages II and III rectal cancer. The patients were
submitted to a total dose of 41.6 Gy, delivered in 2.5 weeks at 1.6 Gy per fraction twice a day with a 6-h interfraction
interval. Surgery was performed within 1 week after the end of irradiation. Adjuvant chemotherapy was delivered in a
subset of patients.
Results: Two hundred and seventy nine patients were entered and 250 are fully assessable, with a median follow-up of
39 months. The 5-years actuarial local control (LC) rate is 91.7%. The overall survival (OS) is 59.6%. The freedom from
disease relapse (FDR) is 71.5%. Downstaging was observed in 38% of the tumors.
Conclusion: The actuarial LC at 5 years is 91.7%, although we are dealing with stages II–III LARC, mainly located in the
lower rectum (median distanceZ5 cm). The pattern of failure is dominated by distant metastases and treatment intensification will obviously require a systemic approach.
q 2006 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 79 (2006) 52–58.