**Author details**

*Paper* 

268 Updates on Cancer Treatment

*% Patients with Neoadjuvant Chemoradiotherapy* 

Andreola et al (2001) 61 4/31 (12.9) 3/45 (6.6) 0.4407a

Kim et al *(2009)* 71.2 7/167 (4.2) 31/747 (4.1) 0.98

Total 22/464 (4.7) 72/1589 (4.5) 0.8995a

Pricolo et al (2010) 100 0/10 (0) 0/23 (0)

this also was not statistically significant [54].

*Number of local recurrences/total patients* 

Huh et al *(2008)* 100 1/18 (6) 0/25 (0) 0.058 71.3 81.3 5 years 0.27

Kiran et al (2011) 40 7/198 (3.5) 19/586 (3.2) 0.821a 67.4 66.5 5 years 0.77 Kuvshinoff et al (2001) 100 1/16 (6) 0/12 (0) 53 85 4 years 0.06 Moore et al *(2003)* 100 2/17 (12) 7/77 (9) 0.93 82 85 3 years 0.88

Rutkowski et al *(2008)* 100 4/42 (9.5) 17/122 (13.9) 0.597 65.6 68.7 5 years 0.66

A meta-analysis indicated a higher rate of anastomotic recurrence by only 1.6% in the <1cm margin groups, but this small observed difference was not statistically significant. A systematic review of the literature on sub-1 cm distal margins of resection found in only two papers a possible adverse outcome associated with this smaller margin [54]. However, in these two papers, the percentage of patients submitting to neoadjuvant CRT was less than 5% [59;60].

Distal margins of 8 mm or 5 mm have also been proposed [40;54;56;61], but there is currently not enough data to draw definitive conclusions at this time. The results so far seem to point to these margins also being oncologically safe. Published data on possible adverse oncologic outcomes with 8 mm margins has been documented, but this has occurred in the absence of neoadjuvant CRT [62]. In this case, margins below the 8 mm cutoff point were found to correlate with a significantly higher rate of recurrence and lower rate of long-term survival. However, when the same length of distal margin is evaluated within the context of neoadjuvant CRT, 8 mm margins have not been found to have adverse oncologic outcomes compared to patients having more than 8 mm margins. In this study, the authors did find a higher rate of mucosal recurrence in patients with less than 8 mm margins. They concluded that the probable cause of

a higher rate of mucosal recurrence was tumor shedding into the anastomosis [40].

Another study evaluated patients who had received neoadjuvant therapy with margins less than or equal to 5 mm in regards to 5 year outcome and local recurrence [61]. There was no difference in local recurrence 5 years after surgical intervention. This finding was echoed by a number of similar studies [48;53;54;56] (Table 2). Additionally, a meta-analysis demonstrated a small non-significant rate of anastomotic recurrence by 1.7% in the 5mm group, but again

*Paper Number of recurrences/total patients by margin* 

Kiran et al (2011) 2/25 (8) 9/164 (5.5) 0.41 Rutkowski et al (2010) 3/29 (10.3) 10/231 (4.3) 0.166 Total 6/63 (9.5) 19/414 (4.6) 0.123

≤ 0.5 cm > 0.5 cm

Kuvshinoff et al (2001) 1/9 (11) 0/19 (0)

*(%) <sup>P</sup>*

≤ 1 cm > 1 cm ≤ 1 cm > 1 cm

*by margin (%) P % Survival Years of Follow Up P* 

Jeffrey Meyer, Jie J. Yao and Sergio Huerta\*

\*Address all correspondence to: sergio.huerta@utsouthwestern.edu

University of Texas Southwestern Medical Center, Departments of Radiation Oncology and Surgery, USA
