Gural, ZeynepSaglam, SezerYucel, SerapKaytan-Saglam, EsraAsoglu, OktarOrdu, CetinAcun, HediyeSharifov, RasulOnder, SemenKizir, AhmetOral, Ethem N.2023-02-212023-02-212018-01-0110.4251/wjgo.v10.i1.40https://hdl.handle.net/11443/2427http://dx.doi.org/10.4251/wjgo.v10.i1.40AIM To evaluate the efficacy and tolerability of neoadjuvant hyperfractionated accelerated radiotherapy (HART) and concurrent chemotherapy in patients with locally advanced infraperitoneal rectal cancer. METHODS A total of 30 patients with histopathologically confirmed T2-3/N0+ infraperitoneal adenocarcinoma of rectum cancer patients received preoperative 42 Gy/1.5 Gy/18 days/bid radiotherapy and continuous infusion of 5-fluorouracil (325 mg/m(2)). All patients were operated 4-8 wk after neoadjuvant concomitant therapy. RESULTS In the early phase of treatment, 6 patients had grade III- IV gastrointestinal toxicity, 2 patients had grade III-IV hematologic toxicity, and 1 patient had grade V toxicity due to postoperative sepsis during chemotherapy. Only 1 patient had radiotherapy-related late side effects, i.e., grade IV tenesmus. Complete pathological response was achieved in 6 patients (21\%), while near-complete pathological response was obtained in 9 (31\%). After a median follow-up period of 60 mo, the local tumor control rate was 96.6\%. In 13 patients, distant metastasis occurred. Disease-free survival rates at 2 and 5 years were 63.3\% and 53\%, and corresponding overall survival rates were 70\% and 53.1\%, respectively. CONCLUSION Although it has excellent local control and complete pathological response rates, neoadjuvant HART concurrent chemotherapy appears to not be a feasible treatment regimen in locally advanced rectal cancer, having high perioperative complication and intolerable side effects. Effects of reduced 5-fluorouracil dose or omission of chemotherapy with the aim of reducing toxicity may be examined in further studies.Hyperfractionated accelerated radiotherapyRectal cancerNeoadjuvant chemoradiotherapyArticleWOS:000419892600005