8%), and in both of these patients the intramucosal spread was <1 cm (36). Moore et al. did not identify distal margin <1 cm

as a predictor of local recurrence after neoadjuvant chemoradiation (37). Therefore, patients with good response to neoadjuvant chemoradiation have the possibility of enhanced sphincter preservation, and in patients in whom the requirement of APR is equivocal, it is reasonable to consider neoadjuvant therapy in an attempt to enhance rates of sphincter preservation. It should be recognized, however, that data supporting sphincter preservation following chemoradiation in patients who would otherwise require APR is Inhibitors,research,lifescience,medical based on relatively small numbers of patients, Inhibitors,research,lifescience,medical and equivalence to APR in terms of local control has not been proven in a randomized fashion. Furthermore, the fecal continence rates following low anterior resection requiring intersphincteric resection are likely inferior to conventional coloanal anastomosis, and therefore decisions regarding sphincter preserving surgery need to take into account anticipated sphincter function and its impact on quality of life (38). Toxicity Inhibitors,research,lifescience,medical of radiation The decision of whether or not to use radiation therapy is dependent not only upon the anticipated benefits in local control, but also upon potential toxicities. The authors of the MRC CR07 completed prospective quality of life questionnaires for

patients who underwent short course neoadjuvant radiation therapy versus selective postoperative chemoradiation (39). As noted previously, only 12% of patients in the selective postoperative chemoradiation group underwent chemoradiation, and therefore this Inhibitors,research,lifescience,medical trial in large part evaluates radiation versus

no radiation in terms of quality of life. There was no difference in physical function, general health, or overall bowel problems between the 2 arms. However, Inhibitors,research,lifescience,medical more patients who received preoperative radiation therapy reported “unintentional release of stools” at 2 years (53% vs. 37%, P=0.007). It is noteworthy that the bulk of patients reported only “a little” unintentional release of stools (43% vs. 29%). Only a minority of patients report “very much” unintentional release Dacomitinib of stool (3% vs. 2%). This analysis also demonstrated that surgery impacted mean male sexual function score by more than 30 percentage points; the addition of neoadjuvant short course radiation to surgery further worsened sexual function score by 8-10%. Therefore, radiation impacted male sexual function, though not to as great a degree as surgery. Reponses from women with regards to sexual function were selleckchem insufficient to analyze. Long term follow-up of the Dutch study similarly showed higher rates of fecal incontinence in patients who received short course preoperative radiation compared to those who did not receive radiation (62% vs. 38%, P<0.