Materials/Methods: Between October 1988 and December 2002, 109 pts with primary rectal cancer underwentpre-operative radiotherapy (RT) associated with CT and RH. 57 out of 109 patients were assessed suitable for surgicalconservative treatment. Clinical stages, as assessed by rectal ultrasound, were as follows T3N0 in 24 pts, T3Nx in 36,T3N� in 33, T4N0 in 3, T4N� in 4, T4Nx in 6, and T3NxM� in 3. Radiotherapy was delivered with daily doses of1.8-2Gy and the median total dose was 62 Gy. The median total dose in this series was delivered and escalated as follows:54 Gy (range 50.4-60) in the firsts 22 pts, 56 Gy (range 54-66) in the second group of 44 pts (range 54-64), 62 Gy (range54-66) in the third group of 22 pts, and 64 Gy (range 62-68) in the fourth group of 25 pts. Chemotherapy consisted ofa continuous infusion of 5FU at the doses of 200 mg/m2 day for all the period of the radiation treatment in 74 pts, andwas associated with a weekly bolus of Oxaliplatin at the doses of 45-65 mg/m2 for the first 4 weeks of the treatment in35 pts. Regional hyperthermia was delivered by using the sigma 60 applicator BSD 2000 and was performed once weeklyprior to radiotherapy for the first four weeks.

Results: The treatment was well tolerated without any significant side effect. All but 6 patient had surgical resection of thetumour, which was complete in 94 cases and incomplete in 9. In 76 cases the surgeon was able to perform a conservativesurgery. Six pts, with a clinical complete response refused surgery and were submitted to an intensive surveillance protocol.Pathological stages resulted as follows: no evidence of tumour in 28 pts, pTmic-pT2 pN0 M0 in 23, pTmic-pT2 pN�M0 in 3,pT3pN0M0 in 30, pT3pN�M0 in 11, pT3pN�M�(lung res.) in 2 pts, pT4 pN0 M0 in 2, pT4pN�M0 in 1, pT0pN0M�(liverres.) in 2, and pT3pN0pM�(lung res.) in 1. With regard of surgical complication, 27% had a radiological evidence of fistula(mainly in pts with colo-anal anastomosis) which delayed the time to restore the canalization and was not related to the radiationdose. All patients with residual disease where submitted to a 5-FU based chemotherapy. Of the 6 pts that refused the surgery,5 are still disease free (mean follow up 24 months) after receiving a radiation dose of 66 Gy, while l pt, who received a radiationdose of 58 Gy, showed liver disease after 6 months and than died 8 months later. A multivariate analysis showed that radiationdose � 60 Gy, tumour length less than 3 cm were related to a higher rate of complete pathological responses. The actuarialsurvival at one, two, tree and four years is 100%, 95%, 90%, 80%, respectively. Two pts showed local recurrence that wassuccessfully operated in one case.

Conclusions: In our experience this trimodality treatment for pts. affected by rectal cancer is effective. Dose escalation was welltolerated and may have contributed to an increase of the complete pathological response rate.

2074 Local Excision in Combined Modality Treatment of Anal Carcinoma

R. Graf,1 W. Tilly,1 B. Hildebrandt,2 G. Sreenivasa,1 H. Goegler,3 R. Felix,1 P. Wust1

1Center of Radiation Medicine, Charite Medical School, Campus Virchow Clinic, Berlin, Germany, 2Medical Clinic forHamatology and Oncology, Charite Medical School, Campus Virchow Clinic, Berlin, Germany, 3Surgical Department,DRK-Hospital, Westend Clinics, Berlin, Germany

Purpose/Objective: To evaluate the value of local excision in comparison with incisional biopsy preceding combined modalitytreatment with respect to local control and survival in patients with anal carcinoma treated by radiochemotherapy (RCT).

Materials/Methods: Between 4/1987 and 6/2000 a total of 84 patients completed primary treatment of anal carcinoma withsimultaneous RCT. The mean total dose was 45 Gy with a dose range of 43-47 Gy. In the majority of patients only an incisionalbiopsy (INC) was performed for the histopathological verification. Other patients underwent surgery prior to the RCT-courseas an excision biopsy (EXC), removing all gross cancer, but leaving a clear residual tumor load in most cases. Thechemotherapy consisted of a continuous infusion of 5-fluorouracil (800/1000 mg/m2/d, on 4/5 consecutive days, during weeks1�5) together with a short infusion of mitomycin C (1-2 � 10 mg/m2). Using computer-assisted treatment planning, the tumorand lymphatics of the true pelvis were treated with a radiation dose of 45 Gy, applying shrinking fields after 30 Gy. 83 patientswere evaluable and their data were analysed with regard to prognostic factors.

Results: 22 Patients had been treated with local excision (EXC), 61 patients had only an incisional biopsy (INC) beforedefinitive treatment. According to tumor stage there were 5 T1, 16 T2 and one T3 in the EXC group (compared to 7 T1, 25T2, 23 T3 and 6 T4 in the INC group) and their resectional status was R2 in 14, R1 in 4 and R0 in 4 cases. Most patient andtreatment characteristics were evenly matched in the EXC and INC group, but, as to be expected, patients in EXC group hadsignificantly smaller tumors (mean 3 cm vs. 4.3 cm, p � 0.02) and lower tumor stages (p � 0.08) and also lower nodal stages(p � 0.02). The actuarial control rate achieved by combined modality treatment for the EXC group was 71.8 % after 5 years,not significantly better than for the INC group with 66.7% and also the 5-year actuarial survival rate was slightly superior with71% vs 68% without a significant advantage. A univarate analysis of prognostic factors was performed. There proved tumorstage T3-T4 (p � 0.02), tumor size of 6 cm or more (p � 0.00), nodal stage N1-3 (p � 0.00) and overall treatment time � 40days (p � 0.05) to be significantly correlated with poorer local control. Local excision was not significantly correlated withbetter local control (p � 0.45) compared with incisional biopsy nor was correlated with better survival. In a multivariate analysisonly tumor size (p � 0.02) and the overall treatment time (p � 0.04) showed prognostic relevance for local control.

Conclusions: Our data suggest that in patients with anal carcinoma treated by radiochemotherapy with a radiation dose of 45Gy, there is no advantage for local excision preceding combined modality treatment compared with an incisional biopsy.

2075 A Comparison of Chemoradiotherapy With or Without Surgery in the Treatment of EsophagealCarcinoma

D.A. Buck,1 E. Frechette,2 B.J. Kaplan,2 J.E. Shaw,3 J.P. Neifeld,2 K. Dawson,4 R. Schmidt-Ullrich,1 T.D. Chung1

1Radiation Oncology, Medical College of Virginia, Richmond, VA, 2Surgical Oncology, Medical College of Virginia,Richmond, VA, 3Medical Oncology, Medical College of Virginia, Richmond, VA, 4Biostatistics, Medical College ofVirginia, Richmond, VA

Purpose/Objective: Multimodality therapy for the treatment of esophageal carcinoma is being utilized with increasing frequency,however the efficacy of newer chemotherapy combinations has not been established. The objective of this study was to determine theoutcome of multimodality treatment with a novel chemotherapy combination delivered concurrently with radiation. This regimen,delivered preoperatively and definitively in patients with esophageal carcinoma, was reviewed at a single institution.

S387Proceedings of the 45th Annual ASTRO Meeting