Thirty-six patients entered the study, of whom 34 proceeded to surgery. Two of these died postoperatively and three patients underwent resection of the primary but had irresectable liver or pleural metastases trichostatin a mechanism of action which were either deemed resectable upon study entry or uncertain in CT scan. Thus, a total of 29 patients were followed-up after potentially curative resection. Of these, three patients (10.3%) developed distant metastases (lung and/or pleura n=2; lymph nodes n=1). One single patient developed local recurrence after 15 months and underwent salvage surgery. Of note, this patient had a ypT4N2 tumour after primary surgery. Considering all patients included in this trial, nine out of 36 patients (25%) have died, of whom four succumbed tumour-related.

Among these, two patients had metastases at the time of diagnosis and one patient had refused potentially curative sugery. Three patients died non-tumour related (17.7, 29.5, and 39.5 months after the start of therapy). Considering all patients (n=36) actuarial calculated overall survival is 83% at 2 years (patients at risk n=23), and 78% at 2.5 years (patients at risk n=15). DISCUSSION Several trials on perioperative therapy in rectal cancer have significantly contributed to a better understanding of an optimized therapeutic strategy during the past few years. It could be demonstrated that (i) the best way to deliver radiotherapy is neoadjuvant (CAO/AIO-ARO-94 trial (Sauer et al, 2004; MRC CR07 �C Sebag-Montefiore et al, 2006), (ii) adding 5-FU to neoadjuvant radiotherapy improves the pCR and the local recurrence rates albeit by the price of higher acute toxicity (EORTC 22921 �C Bosset et al, 2005; FFCD 9203 �C Gerard et al, 2005), (iii) postoperative 5-FU based adjuvant therapy might further improve disease-free survival (n.

s.) (EORTC 22921 �C Bosset et al, 2005). Nevertheless, none of these strategies has either decreased the rate of distant metastases or led to improved survival results. One strategy Dacomitinib to improve overall survival and decrease the rate of distant failure is the intensification of preoperative chemoradiation. By using several drugs during neoadjuvant radiotherapy it is hoped that the local R0-resection rate further increases and that a higher amount of distant metastases is eradicated at the earliest time point. Intensification of postoperative chemotherapy in early-stage colon cancer patients has already proven to ameliorate the results of adjuvant treatment. Both the MOSAIC and the NSABP C-07 trial have unequivocally demonstrated an improved 3-year disease free survival (DFS) using adjuvant oxaliplatin in combination with 5-FU/FA regimen for the adjuvant treatment instead of using 5-FU/FA alone (Andr�� et al, 2004; Wolmark et al, 2005).