Presence of extramural venous invasion (EMVI) by magnetic resonance imaging (MRI) is an independent poor prognostic factor in locally advanced rectal cancer (LARC). Nevertheless, the efficacy of both pre-neoadjuvant therapy (NAT) and post-NAT MRI EMVI assessment to predict pathological response and long-term benefit (in terms of disease-free survival (DFS) and overall survival (OS) has not been clearly established. We analyzed 239 patients with LARC receiving NAT with continuous infusion fluorouracil (n=229) or capecitabine (n=10) diagnosed between 2009 and 2019. Baseline and post-NAT MRI EMVI status was assessed in 214 and 173 patients respectively by two radiologists with more than 20-year and 5-year experience. When discrepancies, EMVI status was decided by consensus. Post-surgical pathologic assessment detached good-responders (ypT0N0 and ypT1-2N0) from poor-responders (ypT3Nx or ypTxN1/2). Three-year DFS and 5-year OS were estimated using Kaplan-Meier product-limit method. Baseline EMVI positive (91/214; 42%) was significantly associated with poor pathological response (74/91; 81%) vs. EMVI negative (52/123; 43%), p=0.0001. In the subset of patients evaluated with pre and post MRI, 69/173 (40%) presented positive EMVI at baseline. 21/69 (30%) patients with positive baseline EMVI became negative after therapy (EMVI (+/-)). Three-year DFS was 80.9% in EMVI (-/-), 66.7% in EMVI (+/-), and 45.2% in EMVI (+/+), HR 1.84 (95% CI 1.38-2.44), p=0.000026. Five-year OS was 82.6%, 73.9% and 57.3%, respectively, with HR 1.67 (95% CI 1.26-2.23), p=0.0004. Baseline EMVI accurately predicted pathological efficacy after conventional NAT. Patients that negativized EMVI (+/-) showed significantly better DFS and OS compared to patients that remained positive EMVI (+/+).

The identification of pathologic complete responder (pCR) patients with locally advanced rectal cancer (LARC) after neoadjuvant treatment (NAT) is of interest in terms of patient prognosis and subsequent therapy options. A four-pattern based evaluation combining diffusion weighted imaging (DWI) and tumor morphology on T2-weighted magnetic resonance has shown promising results in identification pCR. Our aim was to evaluate the performance and reproducibility of this approach in a retrospective series in our center. Pre and post NAT MRI scans obtained in 120 patients with LARC between 2009 and 2014 were retrospectively evaluated by 2 radiologists with 20 and 3 years of experience respectively. Due to artifacts in DWI, tumoral mucine or absence of pathologic specimen, 79 patients were finally evaluated. Reviewers (R), blinded to pathologic final result, assigned 1 of 4 morphologic and DWI tumoral response patterns to every case, including assessment of the absence or presence of residual tumor. R1 and R2 identified 6 and 5 of 15 patients with pCR respectively. Assignments of patients to each group and data on sensitivity and specificity both global and per group are listed in the table. Correlation for pattern assignment between both reviewers showed a k=0.68.Table: 427PGlobalABCDReviewer1212121212n7932231817263732Sensitivity978796801001009485100100Specificity4033100100001220-- Open table in a new tab The identification of residual tumor with DWI in LARC after NAT can be achieved with high sensitivity and modest specificity. Distinguishing morphologic and DWI patterns allow us to select a group with very good results (pattern A) and identify a group in which pCR rarely occur (pattern B). Group classification of patients into each group could be done with good correlation between reviewers. The majority of the discrepancies concentrate in patterns A and C assignments.

Initial results of Chemo-Radiotherapy for esophageal cancer followed by Surgery Study (CROSS) in locally advanced resectable esophageal and esophagogastric junction (EGJ) cancer showed better outcomes in favor of the neoadjuvant chemoradiotherapy plus surgery group. Our goal is to describe the overall survival (OS) and its correlation with the response by PET-CT (rPET) in esophageal cancer (EC). We performed a retrospective study of locally advanced esophageal and EGJ cancer patients treated in our center using the CROSS trial scheme of weekly administration of carboplatin and paclitaxel for five weeks and concurrent radiotherapy (41.4 Gy in 23 fractions, five days per week) followed by surgery. We calculated the metabolic response with the SUVmax difference between the diagnostic PET-CT and the assessment after the chemoradiotherapy (CRT). We used Kaplan-Meier curves plotted for OS and log-rank test for association between rPET and OS. A total of 92 patients were diagnosed between 2013 to 2018 with resectable EC. All patients were diagnosed with upper gastrointestinal endoscopy and histologic biopsy. 87% underwent endoscopic ultrasonography (EUS). Extension staging was made with PET-CT in 88 patients. 45 (48.9%) had adenocarcinoma and 47 (51.1%) had squamous-cell carcinoma. Most tumors were located in the distal esophagus (28.3%) or EGJ (37%), the rest were middle and proximal esophagus. 78.6% of patients had positives lymph nodes by EUS. All patients completed concurrent CRT. The main toxicity related to CRT was hematologic (23%) and esophagitis (27%), with no grade 3 or higher toxic effect reported. The evaluation after CRT was assessed with PET-CT through morpho-metabolic response in 84 (91.3%) patients, with partial response in 62 (67.4%) and complete response in 8 (8.7%) patients. The median difference between PET-CT at diagnosis and post-CRT evaluation, assessed by SUVmax, was 10.8. Sixty-three (68.5%) patients underwent surgery, the remaining patients progressed during CRT or during the interval to surgery, or refused the intervention. One patient died after surgery, with no other major postoperative complications. Complete resection was achieved in 85.7%. Pathological complete response was seen in 14 (15.2%) patients. With a median follow-up of 30 months, we observed a median OS of 28 months, being significantly higher in operated patients (70 vs 15 months; p < 0.0001). There was no survival benefit in relation to the rPET, observing an OS of 28 months vs 29 months, in patients with differences greater than 10.8 vs. lower than 10.8, respectively (p = 0.79). The results of this study are in accordance with published reports, confirming that trimodality therapy for potentially resectable EC brings benefit in OS with a safe toxicity profile. Results indicate that there is no correlation between rPET and OS. Further data is necessary to validate the metabolic response as an outcome predictor.

Introduction: The benefit of adjuvant chemotherapy for patients with rectal cancer and pathological complete response (pCR) after preoperative chemoradiation (CRT) and surgery, is controversial. We evaluated long-term oncological outcomes, in two prospective cohorts of rectal cancer patients treated in our Institution. Methods: All patients received neoadjuvant chemotherapy (fluorouracil 225mg/m2/day x5 days) and concomitant radiotherapy (45Gy) for five weeks, followed by LapTME or TaTME after 5-8 weeks. Patients who achieved ypT0N0, complete pathological responders (CR) were not treated with adjuvant therapy, according to our Institution policy. Patients with ypT1-2N0, intermediate responders (IR) and ypT3-4 or ypTxN1, poor responders (PR) were offered fluoropyrimidine-based adjuvant treatment on an individual basis. Results: Cohort 1 includes 176 patients from 12/2000 through 12/2008, staged by endoscopic ultrasonography, whereas the cohort 2 included 172 patients from 11/2009 through 12/2015 staged with magnetic resonance imaging. Cohort 1: 171/176 (97.2%) had radical surgery and 19.9% had an abdominoperineal resection (19.9%). The median number of lymph nodes identified in the surgical specimen was 12 (range 0-33). Pathologic complete response (CR) was achieved in 27/171 (15.3%), IR in 47/171 (27%) and PR in 97/171 (55.1%). 11/47 (23%) IR and 47/97 (48%) PR received adjuvant therapy. After a median follow up of 58.3 months (range 3.8-129.8), five-year DFS was 96.3%, 89.4% and 53.6% in the CR, IR and PR groups, respectively (p < 0.0001). Five-year OS was 100% 89.4% and 69.1% in the CR, IR and PR groups, respectively (p < 0.0001). Cohort 2: The presence of EMVI, EMVI+ 72/160 (45%) before neoadjuvant treatment, was associated with a PR (p < 0.0001). Five-year OS was 91.7%, 87.2% and 67.3% in the CR, IR and PR groups, respectively (p = 0.012). Conclusion: Our long term oncologic outcomes obtained in rectal patients who achieved ypT0N0 after neoadjuvant treatment and either LapTME or TaTME, does not support the administration of adjuvant therapy.

Introduction: Systemic inflammation is a recognised feature of cancer progression and some inflammatory biomarkers such as Neutrophil-to-Lymphocytes Ratio (NLR) emerge as important prognostic factors of survival outcomes and several studies were carried out to explore NLR in pancreatic cancer. Despite the great interest in the role played by neutrophils in antitumour immunity, other subpopulations of leukocytes, such as eosinophils, seem to be overlooked in cancer setting. We evaluated the prognostic value of NLR in patients diagnosed with pancreatic carcinoma and treated with chemoradiation in our institution, and subsequently we proposed new eosinophil-based ratio expressed as Eosinophil-to-Lymphocyte Ratio (ELR), and we analysed its impact on overall survival of the same cohort of patients. Methods: A total of 60 consecutive patients diagnosed with pathologically-confirmed locally advanced pancreatic cancer in stage I-III and treated with chemo-radiotherapy in our institution from September 2010 to November 2017 were retrospectively evaluated. Three patients who did not complete radiotherapy were eliminated, hence the analysis was based on the data of 57 patients. We analysed the relation between overall survival (OS) and systemic inflammatory biomarkers in blood tests at cancer diagnosis. The ELR was calculated as follows: eosinophil count/lymphocyte count. All patients were divided into two groups using the most discriminative cut-off value of 1.9 for NLR and 0.11 for ELR according to the ROC curves. Statistics: Chi2, Kaplan-Meier test (SPSSv.23), p-value 0.1. Results: Median age at diagnosis was 66.0 years (range 43-83), 33 patients were males (57.9%). Cancer stage at diagnosis was IA in 5 patients (8.8%), IB-5 (8.8%), IIA-9 (15.8%), IIB-30 (52.6%), III-8 (13.5%). Main histology was adenocarcinoma 44 patients (77.2%), localised in the head of the pancreas (41 patients, 71.9%). All patients were treated with chemoradiation based on weekly gemcitabine and External Beam Radiotherapy (EBRT) at a dose of 45Gy (range 32 – 45Gy). Twenty six patients underwent surgery. After a median follow-up of 15.6 months (range 3.4 – 122.0, mean 18.9, SD 16.8), 47 patients (82.5%) were dead at the time of data collection. Kaplan-Meier analyses showed that a high NLR (≥ 1.90) correlated significantly with a shorter OS of cancer patients showing a median OS of 14.6 months in group with NLR ≥ 1.90 (IC 95% 10.8 – 18.4) vs. 26.2 months (IC 95% 13.4 – 38.9) in group with NLR < 1.9 (p = 0.033 Log Rank test, Chi2=4.3, p = 0.019 Breslow, Chi2=5.1). However, a high ELR (≥ 0.12) were associated with better OS, showing a median OS of 21.4 months (IC 95% 11.0 – 31.7) vs. 15.6 months (IC 95% 11.5 – 19.7) in a low ELR group (p = 0.067 Log Rank test, Chi2=3.4, p = 0.057 Breslow, Chi2=3.6). Conclusion: Increased value of NLR was related with worse OS but high ELR correlated with better survival outcome in pancreatic cancer treated with chemoradiation. These results could help identifying patients with higher risk of progression, with the additional benefit that both NLR and ELR are inexpensive and easy to get from the pre-treatment analysis. To our best knowledge, this is the first report evaluating the prognostic value of ELR in pancreatic cancer.

Metastatic tumours to the nasal sinus are an exceedingly rare event. We describe a case of metastases to the nasal sinus simultaneously with brain metastases from a colonic adenocarcinoma. An 85-year-old man came to our hospital presenting epistaxis and headache. Diagnosis of the biopsy specimen showed it was a metastasis of the previously managed tumour. The patient underwent palliative radiotherapy.

BACKGROUNDBased on a phase I study showing the feasibility of combining of oxaliplatin, cisplatin, and 5-fluorouracil (5-FU) (OCF) with radiation therapy (RT) in esophageal cancer, the efficacy of this regimen in esophageal, gastroesophageal (GE), and gastric (G) cancer was assessed in this phase II multicenter study.PATIENTS AND METHODSPatients with resectable tumors were eligible. Treatment included two cycles of oxaliplatin 85 mg/m(2), cisplatin 55 mg/m(2), and continuously infused 5-FU 3 g/m(2) in 96 h and concurrent RT (45 Gy), followed by surgery after 6-8 weeks. Primary end point was complete pathologic response (pCR).RESULTSForty-one patients were enrolled. Tumor location was esophagus 39% (squamous 10/adenocarcinoma 6), GE junction 32%, and stomach 29%. G3-G4 adverse events included asthenia (27%) and neutropenia (14%). One toxic death occurred. Thirty-one patients (75.6%) underwent surgery (R0 in 94%). Pathologic response was achieved in 58% of patients, with pCR in 50% and 16% of esophageal and GE/G cancer, respectively. pCR was achieved in 67% of squamous cell carcinoma. Survival: median follow-up, 50.4 months; median progression-free survival and overall survival were 23.2 and 28.4 months, respectively.CONCLUSIONPreoperative OCF plus RT showed an acceptable toxicity and promising activity especially in squamous cell esophageal cancer.

3634 Background: QRTP and subsequent TME is the standard treatment in patients with stage II-III RC. Laparoscopic surgery in RC is not a standard treatment. We present long-term outcomes in patients with RC treated with QRTP and TME by LPS. An interval < 8 vs. ≥ 8 weeks between treatment completion and surgery as a predictive factor of pathological complete remission (pCR) was also analyzed (Kalady, Ann Surg 2009). Methods: We analyzed all patients with rectal cancer treated with QRTP and TME by LPS at the Hospital Clinic of Barcelona between 2000 and 2008. Tumor staging was performed with endorectal ultrasonography, abdominal helical CT and chest radiography. Neoadjuvant treatment consisted of 45 Gy delivered in fractions of 1.8 cGy/day concomitant with 5-fluorouracil given in a 120-hour continuous infusion at a dose of 225 mg/m2/d for 5 weeks. Results: Of 423 patients operated by LPS, 164 received QRTP achieving radical surgery in 156. Median follow-up 43.8 months. 17.9% of patients achieved a pCR. Subgroup of patients with good pathological response (n = 70, ypT0-2 N0) obtained better oncological results at 5 years than patients with poor pathological response (n = 86, ypT3-4NX, ypTxN1-2) in local recurrence (0% vs. 10.4% p = 0.004), relapse-free survival (92% vs. 54.8% p < 0.001) and overall survival (90.1% vs. 60.7% p < 0.001). On multivariate analysis, pathological response ypT0-2N0 was the only predictive factor for overall survival (HR 6.02 IC95% 2.08-17.45). An interval ≥ 8 weeks between treatment and surgery was not associated with a higher rate of pCR (HR 1.47 p = 0.365). Conclusions: Patients with rectal cancer treated with QRTP and TME by LPS have long-term outcomes comparable to open surgery. An extended interval between treatment and surgery is not a predictive factor of pCR in our analysis. No significant financial relationships to disclose.

e15598 Background: 1) To evaluate the usefulness of Positron Emission Tomography with combined 18F-Fluorodeoxyglucose with Computed Tomography (PET/CT) in the diagnosis of distant metastases in patients with gastric adenocarcinoma (GAC) compared to spiral double contrast thoracoabdominal Computed Tomography (CT); 2) To establish the utility of PET/CT in the detection of peritoneal carcinomatosis compared to laparoscopy. Methods: Thirty prospective patients (22 men, 8 women; mean age 67±11) who underwent endoscopic ultrasound and were classified as T2–3N1 or T3Nx GAC were included in this study. Whole body images were obtained 1 hour after injection of 370 MBq of 18F-Fluorodeoxyglucose. CT was performed within 2 weeks of PET/CT. Laparoscopy was performed without remarkable incidences. All findings were confirmed by histopathology examination and/or by at least 6 months follow- up. Results: Distant metastases were found in 9/30 cases: carcinomatosis (3), retroperitoneal (3) or mediastinal (2) pathological lymph nodes and one case of bone metastases (1). PET/CT diagnosed unsuspected distant metastases by CT in 4/9 patients (retroperitoneal (1) or mediastinal (2) pathological lymph nodes and 1 case of bone metastasis in the spine). In 1/3 patients with histopathological confirmed diagnosis of peritoneal carcinomatosis by laparoscopic findings was negative by PET/CT, and considered as a false negative case. On the other hand, 3 patients with initially positive peritoneal carcinomatosis by invasive laparoscopy were finally diagnosed as benign lesions. These lesions did not show significant uptake in PET/CT and were considered as true negative cases. Conclusions: 1) PET/CT is useful in the diagnosis of distant metastases in patients with GAC 2) Further studies are needed to establish the role of PET/CT to detect peritoneal carcinomatosis. No significant financial relationships to disclose.

Objective. To determine the prognostic value of detecting tyrosinase transcripts in melanoma sentinel lymph nodes (SLNs).Methods. Reverse transcription (RT) PCR for tyrosinase mRNA was performed on negative SLNs of 76 patients with melanoma.Results. Tyrosinase mRNA was found in 39 patients (51.3%). After a median follow-up period of 51 months, significant differences were found in overall survival (OS) but not in disease-free survival (DFS). The 5-year OS and DFS rates were 97.2% and 80%, respectively, for RT-PCR tyrosinase-negative (TN) patients vs. 78.67% and 66.24% for RT-PCR tyrosinase-positive (TP) patients (P = 0.019 and P = 0.38, respectively). Of four progressing patients in the TN group, three relapsed with subcutaneous, soft-tissue or lymph-node metastases, while seven out of nine progressing patients in the TP group relapsed at visceral sites.Conclusions. No significant differences in DFS were found by RT-PCR tyrosinase expression analysis at melanoma SLNs. Significant differences in OS could be related to a different pattern of relapse and must be confirmed after a longer follow-up time.

e15612 Background: A phase I study showed the feasibility of the triplet combination (OPF) with XRT in ES and GE cancer (Maurel et al, IJRBOP, 2005). We conducted a phase II study to evaluate the efficacy of the regimen. Methods: Enrolled pts had resectable, high-risk (HR) based on endoscopic ultrasonography (EUS) (uT3, uN1 or uT4 if deemed resectable) ES, GE and G cancer. The primary objective was to determine the pathologic complete response (pCR). If 2 or more pCR were reported in the first 18 pts treated, enrollment continues with 23 additional pts. Eligibility criteria: squamous cell or adenocarcinoma of the ES, GE or G cancer and ECOG Performance status (PS) 0–1. Staging was done with EUS and computed spiral tomography. Laparoscopic staging was mandatory for pts with ES, GE and G adenocarcinoma. Pts received 2 cycles of O 85 mg/m2, P 55 mg/m2, F (3 g/m2 in 96h CI) q4w, with concomitant 45 Gy XRT in 25 fractions; surgery was planned 5–8 weeks after XRT. All pathological specimens were reviewed by a unique pathologist and regression analysis was recorded using Cologne (C) and M.D.Anderson (MDA) classification for ES and European Journal of Surgical Oncology (EJSO) for GE and G. Results: Between 5/04 to 12/07, 41 pts were enrolled in 5 Spanish Institutions. Median age 62 yrs (39–75 yrs); Male/female 83%/17%; PS 0/1 27%/73%; ES/GE/G 39%/32%/29%; EUS stageT3N0 (20%), T2–3N1 (65%) and T4 (10%). G3/4 adverse events included asthenia (27%), infection (7%), diarrhea (7%) and stomatitis (5%). There were 2 toxic deaths. Of the 31 pts who underwent surgery, there were R0=94%/R1=3%/R2= 3%. 7/41 pts (17%) achieved pCR. Using C and MDA classification, 9/14 (61%) and 12/14 (85%) ES achieved grade IV/III and P0/P1 regression, respectively. With EJSO classification 3/17 (18%) GE and G tumors achieved pCR. Median time to progression or death (PFS) was 16.2 (CI:12.2-NR) months (mo). Median overall survival (OS) was 28.9 mo. (CI: 22.5-NR). Conclusions: Although in the whole group pCR, PFS and OS does not appear superior to results achieved in other trials with preoperative P/F/XRT in HR pts, the OPF regimen seems specially active in ES cancer. No significant financial relationships to disclose.

BACKGROUND:Lip cancer is frequently treated with surgery although radiation therapy offers comparable results. The aim of the study was to evaluate the local cure rate in patients with lip carcinoma treated with 192-Ir low dose rate interstitial brachytherapy.METHODS:Fifty-four patients with a mean age of 70 years (range, 40-90 years) were retrospectively evaluated. The tumour location was the superior lip in 4 (7.4%) and the inferior lip in 50 (92.6%). Tumour stage was T1N0 in 33 patients and T2N0 in 21 patients. The radioactive sources with hypodermic needles in 49 patients (90.7%) and plastic tubes in 5 (9.3%) were placed parallel and equidistant from one another across the tumour volume according to the Paris system rules.RESULTS:The median dose was 61.5 Gy (range, 60-65 Gy). All patients experienced acute brisk skin and mucositis RTOG grade III around the implanted volume, subsiding within 4-6 weeks after the implant. Local control was achieved in 98% of patients. The mean follow-up was 7 years.CONCLUSIONS:Low dose rate interstitial brachytherapy with 192-Iridium is a well established and efficacious way to achieve local control of the tumour in lip cancer. It offers the advantage of avoiding surgery in an elderly population.

Bone fracture is a well known possible late complication of radiation treatment. Little has been written about fractures of long bones after irradiation. We present a case of femur bone necrosis secondary to postoperative radiation for a soft tissue sarcoma of the thigh 20 years earlier. Fixation of the diaphyseal fracture and radiological evolution are described.

Intramedullary spinal cord metastases (ISCM) are uncommon and present with rapidly progressing neurological deficits. The objective of this study was to determine the rate, duration of neurological response and survival after radiation therapy. We have retrospectively reviewed the clinical outcome of six cases with a diagnosis of ISCM from primary lung cancer, non-small cell (NSCLC) (n=3) and small cell (SCLC) (n=3). Total radiation dose ranged from 27 Gy/5 fr to 40 Gy/20 fr. Ambulation was preserved in 3 patients and partially recovered in one. Five out of the six patients (83%) showed improvement in neurological signs/symptoms with a mean duration of 17.2 days (max: 40 days; min: 6 days). Median survival time was 5 months (confidence interval (CI) 95%: 0–12) for NSCLC and 5 months (CI 95%: 4–6) for SCLC. Although radiation response rate is high, the interval free of neurological progression is very short. A therapeutic approach should be considered for each individual.

BACKGROUND:Serum levels of melanoma markers may have a role in monitoring disease evolution in metastatic melanoma.PATIENTS AND METHODS:Serial measurements of melanoma inhibiting activity protein (MIA), lactate dehydrogenase (LDH), S-100 and beta2-microglubulin were obtained from 42 metastatic melanoma patients during their biochemotherapy treatment.RESULTS:High pre-treatment serum levels of S-100, LDH, MIA and P2-microglobulin were detected in 50%, 57%, 50% and 24% of the patients, respectively. Only S-100 had prognostic significance for both disease-free (p=0.011) and overall survival (p=0.021). In patients who responded to treatment, S-100 levels decreased significantly from pre-treatment to the time of response (p = 0.050). When patients progressed, levels of MIA and P2-microglobulin increased significantly (p =0.028 and p =0.030, respectively).CONCLUSION:Correlation with disease evolution was found for S-100, MIA and P2-microglobulin levels. Despite the small sample size of the study, S-100 was a significant prognostic marker for overall survival and disease-free survival.

14556 Background: To establish the feasibility and efficacy of capecitabine with weekly irinotecan (CAPIRI) and concurrent radiotherapy (RT) in patients with locally advanced and resectable metastatic rectal cancer, followed by LAME. Methods: Eligible criteria included adenocarcinoma of the rectum staged by endoscopic ultrasonography (us), spiral abdominal and pelvic CT and chest X-ray. Patients received weekly irinotecan 50 mg/m2 (days 1,8,15,22,29) and two doses of capecitabine (days 1 through 5 for 5 weeks); dose level; (DL) I 250 mg/m2 bid; DL II 375 mg/m2 bid; DL III 500 mg/m2 bid, according to phase I methodology. Conformal radiotherapy was administered up to a total dose of 45 Gy/1.8 Gy per fraction. LAME was planned 5–7 weeks after CRT. Results: From January 2003 to March 2006, 22 patients (three with potentially resectable metastatic disease) were included. Median age was 62 (range 48 to 78). 6 pts were usT3N0 and 16 pts usT3–4N1. Seven patients were treated at DL I, six at DL II and nine at DL III. Grade 3 or 4 adverse events were observed in all levels; DL I asthenia (1p); DL II diarrhea (2p) and DL III asthenia and neutropenia (1p), diarrhea (1p) and hyperbilirrubinaemia (1p). All patients except one who refused treatment after 1 week therapy (DL I), completed CRT and underwent surgical resection (R0 81%, R2 19%). Abdominoperineal resection was done in two cases (9%). Conversion rate to open surgery was 5%. Median hospital stay was 7.9 days. The overall postoperative morbidity was 4.7%. Median excised nodes were 11 (range 4–21). Pathological complete response was observed in two patients (9%), both of them in DL III. With a median follow-up of 25 months (range 9–46), disease free survival and overall survival was 67% and 95% respectively. Conclusions: Preoperative CRT with CAPIRI is feasible, but severe adverse events were found in all levels despite the use of lower dose of capecitabine than previously published. LAME after CAPIRI had short oncologic outcomes comparable with open mesorectal excision. No significant financial relationships to disclose.